HEALTHY PEOPLE LIBRARY PROJECT

American Association for the Advancement of Science

Having Healthy Babies

The Science Inside

XX
Having Healthy
Babies: The
Science Inside

HEALTHY PEOPLE LIBRARY PROJECT

American Association for the Advancement of Science
Published 2003 by The American Association for the Advancement of Science (AAAS)
1200 New York Avenue, NW
Washington, DC 20005

© Copyright 2003 by AAAS

0-87168-694-5

All rights reserved. Except for use in a review, no part of this book may be reproduced,
stored in a retrieval system, or transmitted in any form, or by any means, electronic,
mechanical, photocopy, recording, or otherwise, without prior permission of AAAS.

This booklet is a product of the Healthy People 2010 Library Initiative funded by the
National Institutes of Health (Grant # 5R25RR15601).

Any interpretations and conclusions contained in this booklet are those of the authors
and do not represent the views of the AAAS Board of Directors, the Council of AAAS,
its membership or the National Institutes of Health.
TABLE OF CONTENTS

INTRODUCTION: NATURE PLUS KNOWLEDGE . . . . . . . . . . . . . . . . . 1

PART 1: WHO’S AT RISK IN PREGNANCY? . . . . . . . . . . . . ........3

Risk factors and risk disparities . . . . . . . . . . . . . . . . . . . . ........3
How risk factors cause harm . . . . . . . . . . . . . . . . . . . . . . ........4
Reducing risks: Maternal health before pregnancy . . . . . ........8

PART 2: WHAT IS A HEALTHY BABY? . . . . . . . . . . . . . . . . . . . . . . . 11

Healthy conception . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Healthy development. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11
Healthy birth . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12
Healthy infancy and early childhood . . . . . . . . . . . . . . . . . . . . . . . 13

PART 3: HEALTH CARE DURING PREGNANCY AND CHILDBIRTH . . 17

Recognizing pregnancy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Prenatal care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17
Nutrition, exercise, and environment . . . . . . . . . . . . . . . . . . . . . . 20
Labor and delivery . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 22
Postnatal care. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24

PART 4: COMPLICATIONS OF PREGNANCY. . . . . . . . . . . . . . . . . . . 27

Infertility . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27
Miscarriage and other pregnancy loss . . . . . . . . . . . . . . . . . . . . . . 28
Diabetes . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29
High blood pressure . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30
Stress, anxiety, and depression. . . . . . . . . . . . . . . . . . . . . . . . . . . . 31
Premature labor and childbirth . . . . . . . . . . . . . . . . . . . . . . . . . . . 32
Neonatal intensive care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34

PART 5: HEALTH CARE OF INFANTS AND TODDLERS . . . . . . . . . . . 37

Caring for an infant at home. . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37
Postnatal medical care . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Risks to infant health . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38
Health in infancy and early childhood. . . . . . . . . . . . . . . . . . . . . . 39
Smart babies: learning through play . . . . . . . . . . . . . . . . . . . . . . . 41
PART 6: NEW RESEARCH ABOUT MOTHERS AND BABIES . . . . . . . 45
Identifying risk factors and risk disparities . . . . . . . . . . . . . . . . . . 45
Discovering causes for pregnancy complications . . . . . . . . . . . . . . 46
Evaluating prenatal and postnatal care. . . . . . . . . . . . . . . . . . . . . 47
The vital role of volunteers . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48

CONCLUSION: MAKING MOTHERS AND BABIES HEALTHIER . . . . . 49

RESOURCES . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51

APPENDIX 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55
Questions to Ask Your Doctor About Pregnancy and Childbirth

APPENDIX 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56
Taking Part in Research Studies—Questions To Ask

APPENDIX 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59
Recommended Early Childhood Immunization Schedule

BIBLIOGRAPHY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 61

GLOSSARY . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63

ACKNOWLEDGEMENTS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70

PHOTO CREDITS . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72
 INTRODUCTION: NATURE
PLUS KNOWLEDGE
M ost people think that human
reproduction “just comes naturally.”
prenatal care early in her preg-
nancy. Nurses, doctors, and other
It is certainly true that women had professionals monitor the health of
been giving birth for thousands of the mother and the growth of the
years before reproduction was baby in the womb. They treat the
understood by science. But for most normal discomforts of pregnancy
of those centuries, pregnancy and and help mothers reduce the risks
childbirth were highly dangerous of the complications of pregnancy.
for both mothers and babies. Today,
because of advances in science, we Every parent needs to have knowl-
know more than ever before about edge about the “natural” process of
how to have healthy babies and how reproduction. They need to know
to keep them healthy. that a baby’s health begins with the
parents’ health—that mothers and
Science and technology have given fathers with healthy lifestyles have
us tools that would have been hard
to imagine just 50 years ago. Now, a
mother can actually see a picture of
her unborn baby in the womb.
Infants who are born too early have
a much greater chance of surviving
than ever before. Doctors can per-
form tests that show parents, even
before the mother becomes preg-
nant, where they might have trou-
ble having a healthy baby. Scientific
research shows which risk factors
can lead to an unhealthy pregnancy
and how to avoid these risks.

Many scientific studies have shown

that mothers who receive good pre-
natal care are at lower risk for
having health problems in preg-
nancy. A mother and her baby are
healthier when the mother seeks
better chances of producing infants
who are born healthy and who stay
healthy. Parents need to know how
the process of childbirth can be
made safer for both mothers and

1
 Having Healthy Babies: The Science Inside

babies. They also need to know how
the proper care of newborn infants
helps them grow up healthy and
strong.
This book summarizes what health
professionals know about healthy
babies and mothers. It also directs
readers to more sources of informa-
tion and to the latest scientific
research. Most of that research
delivers a positive message: pregnan-
cy, childbirth, and infant care can be
safe, happy, and healthy experiences.
Doctors can identify risk factors for
unhealthy pregnancy. Parents can
change their lifestyles to avoid these
risks and give infants the best possi-
ble start in life. Armed with knowl-
edge, mothers can look forward with
peace of mind to the joy of childbirth
and of having healthy children and
families.

Health Professionals for Mothers and Babies

primary doctor: monitors the patient’s overall health, directs medical treatment, and coordinates care

gynecologist: specializes in women’s health

obstetrician: specializes in care of pregnant

women and their developing babies

nurse-midwife: advises mothers on labor and

delivery; delivers babies with physician
emergency backup

pediatrician: specializes in children’s health

lactation consultant: helps women learn to

breastfeed their newborns

dietician, nutritionist: matches the patient with

an eating plan and provides training and support
so the patient eats properly

dentist: regularly checks the mother’s mouth to prevent or treat gum disease

pharmacist: dispenses prescriptions, helps the patient keep track of medications, and offers advice on tools
and supplements

2
PART 1: Who’s at risk
in pregnancy?
Risk factors and risk
disparities
Pregnancy always carries some
health risks, because the needs of
the growing baby make extra
demands on the mother’s body.
Mothers who are not healthy are
more likely to have unhealthy
babies. Scientists have identified
many risk factors that increase the
chances that a mother and her baby
will have health problems. A risk
factor for pregnancy is any behav-
ior or condition that might harm the
mother’s or baby’s health.
Researchers often identify risk
factors by counting how often they
occur at the same time as certain
medical problems. For example,
smoking is a risk factor for an
unhealthy pregnancy. According to
the Office of the Surgeon General,
smoking is probably the most
important risk factor of poor
pregnancy outcomes among women
in the United States. Women who
smoke during pregnancy subject
themselves and their developing
fetus and newborn to special risks,
including an increased risk of
miscarriage, pregnancy complica-
tions, premature birth, low birth
Smoking
and Pregnancy
weight infants, infections, still- • Women who smoke
birth, and infant death. have increased risk
for conception delay
The data on smoking do not provide and for both
a scientific explanation of how primary and
smoking harms the fetus. Nor do secondary infertility.
the numbers allow for other risk • Women who smoke
factors that often go along with during pregnancy
smoking, such as alcohol abuse or risk pregnancy
obesity. The findings are, however, complications,
strong evidence that smoking is one premature birth,
of the causes of low-birth-weight low birth weight
babies. infants, infections,
still birth, and infant
death.
A risk disparity is a noticeable dif-
ference in risk data between mem- • Women who smoke
bers of one racial, ethnic, or other may have a modest
social group and the population as a increase in risks for
whole. For example, researchers ectopic pregnancy
counted the incidence of various (fallopian tube or
risk factors in mothers of different peritoneal cavity
racial origins. The results showed pregnancy) and
spontaneous
that the percentage of health risks
abortion.
in pregnancy is significantly higher
among African Americans than • Studies show a link
among other racial groups. between smoking
and the risk of
Like the smoking data, these sudden infant death
statistics have some limitations. syndrome (SIDS)
For example, the table includes no among the offspring
of women who
categories for mixed races. A mother
smoke during
with one Asian-American parent
pregnancy.
and one African-American parent
would have to be assigned to just
3
 Having Healthy Babies: The Science Inside
Low and Very Low Birthweight Births
by Maternal Race, United States 2000
Percent
0
White
Low birthweight is less than
2500 grams (5 1/2 pounds)
Very low birthweight is less
than 1500 grams (3 1/3 pounds)
one of the groups for reporting pur-
poses. However, for all their limita-
tions, risk disparities can be clues
to the causes of health problems and
can guide researchers in their search
for cures.
Identifying a risk disparity is not the
same as identifying what causes the
disparity. Risk disparities can be the
result of social conditions (such as
lower incomes and less access to
health care), as well as medical
conditions (such as personal and
family medical problems).
How risk factors cause harm
If a woman understands how risk
factors can harm her health, she
might be motivated to lower her
health risks by getting better health
care, changing bad habits, and paying
4
13.0
Black Native Asian or All Races
Pacific
Source: National Center for
Islander Health Statistics, 2000 final
natality data
Prepared by March of Dimes
Perinatal Data Center, 2002
attention to her own and her family’s
health histories.
Listed below are just a few examples
of risk factors in pregnancy and what
medical science knows about their
causes. These causes include those
that relate to diet, genetics, viruses,
bacteria, smoking, substance abuse,
and teenage pregnancy. More facts
about the health problems of preg-
nant women and infants—and about
the risk factors for those problems—
appear in Parts 3, 4, and 5 of this
book.
Diet. Folic acid deficiency is an
example of a risk factor related to
diet—specifically to folic acid, one of
the B vitamins. Folic acid is found
in green, leafy vegetables and citrus
fruits. It can also be obtained from
most multiple vitamins or other vita-
min supplements. Folic acid contains
 Part 1: Who’s at risk in pregnancy?
chemicals that help build normal
red blood cells and healthy nerve
cells. Without folic acid, the mother
runs a risk of anemia (a shortage
of red blood cells) and other prob-
lems. The unborn baby is also at
risk because it needs folic acid to
develop a healthy nervous system.
The most critical time for the
embryo to get folic acid is during
the first few weeks of pregnancy,
when its nerve cells are first being
formed.
Folic acid deficiency is a leading
cause of spina bifida and other
birth defects of the brain and
spinal cord. Spina bifida, also
called “open spine,” affects the
backbone and the spinal cord and
can cause paralysis of the legs, as
well as problems with bladder and
bowel control. Folic acid deficiency
causes another neural tube defect
called anencephaly. Babies with
this deadly condition are born with
severely undeveloped brains and
skulls. Low levels of folic acid have
also been related to miscarriages,
premature (early) deliveries, and
low birth weight babies.
Genetics. Sickle cell disease is
an example of a risk factor that
is genetic, or inherited. This
disease is caused by a defective
form of hemoglobin, which is
found in all red blood cells. Red
blood cells with normal hemoglo-
bin are round, flexible, and move
easily through the blood vessels
to deliver oxygen throughout the
body. Red blood cells with sickle
cell hemoglobin, however, can
become rigid and bent into a C (or
sickle) shape. Sickled red blood
cells are sticky and can clump
together, forming temporary plugs
in small blood vessels that stop Currently, roughly
one in eight or more
blood flow and cause pain. While
than 500,000 women
normal blood cells live about 120 smoke during preg-
days, sickled cells die after about nancy in the United
10 to 20 days. Because they cannot States. Birth compli-
cations caused by
be replaced fast enough, the blood smoking during
becomes short of red blood cells, a pregnancy or pre-
condition called anemia. Pregnant natal exposure to
secondhand smoke
women with sickle cell disease result in as much as
may suffer more pain and infec- $2 billion in addi-
tions during pregnancy than tional health care
women without the disease. They costs in the U.S.
each year.
are also at increased risk for heart
problems, miscarriage, and According to the
preterm (early) labor. U.S. Agency for
Healthcare Research
and Quality, infant
Sickle cell disease is also danger- respiratory distress
ous because the genetic trait for syndrome and pre-
maturity/low birth
the disease can be passed on to the
weight, which can
unborn baby. If both parents carry both be caused
the sickle cell gene, there is a 50/50 by maternal smok-
chance that their baby will also ing, are two of the
three most expensive
carry the sickle cell gene. Most conditions requiring
cases of sickle cell disease in the hospital care.
5
 Having Healthy Babies: The Science Inside
Why Does Sickle Cell Disease Occur
Only within Certain Ethnic Groups?
Does it seem odd that some diseases only occur within
certain ethnic groups? In the case of sickle cell disease,
only people whose ancestors came from areas of the
world troubled by a deadly disease called malaria can
inherit the condition. And what’s more, although sickle
cell anemia is a serious medical condition, it once
helped keep people alive!
Hundreds of thousands of
years ago, malaria swept
through parts of Africa,
the Mediterranean, the
Middle East, and India.
Although many people
were killed, some sur-
vived. Those who did had
a genetic mutation (an
alteration in a gene) that
caused some of their red
blood cells to form into a
sickle shape. Sickled red
blood cells did not allow
the parasite that causes
malaria to spread
throughout the body.
Some of the malaria sur-
vivors with the mutated
hemoglobin gene had children with other survivors, and
passed the gene on to some of their children. Genera-
tion after generation, the gene was passed on as
carriers had children with other carriers. Over time, as
people migrated throughout the world, so did the sickle
cell gene. Unfortunately, the gene that once helped
people survive malaria can also cause great harm in the
form of sickle cell disease.
United States occur among African
Americans and Hispanic Americans
from the Caribbean. Scientists esti-
mate that about 1 in 12 African
Americans in the United States
6
carries the sickle cell trait. About 1
in every 400 African Americans actu-
ally gets sickle cell disease.
Viruses. Rubella (German measles)
is an example of a risk factor that is
carried by a virus. A virus is a tiny
organism that invades the cells of
living things. Once inside a body, a
virus becomes a parasite, living off
the cells of its host, reproducing
itself, and spreading disease. The
virus that causes rubella is carried
through the mother’s bloodstream
and into the bloodstream of the fetus.
Infection by the rubella virus can
cause miscarriages or stillbirths, or
even congenital rubella syndrome
(CRS). CRS is a group of severe
birth defects, including mental retar-
dation, heart disease, deafness, and
cataracts.
Bacteria. Chlamydia is an example
of a sexually transmitted infec-
tion (STI). Chlamydia is caused by
bacteria. The bacteria enter the vagi-
na during sexual intercourse, where
they multiply and spread to the
uterus, fallopian tubes, and ovaries.
Unless it is treated, chlamydia can
lead to inflammation throughout the
woman’s reproductive system. Pelvic
inflammatory disease (PID)
damages the fallopian tubes, which
can lead to ectopic pregnancy
(tubal pregnancy) or infertility.
Pregnant women with chlamydia are
at greater risk for miscarriage and
preterm deliveries. Mothers with
chlamydia also risk passing the
 Part 1: Who’s at risk in pregnancy?
infection on to their babies during
delivery. Babies born with chlamy-
dia can develop eye infections and
pneumonia.
Smoking. Smoking is an example
of a risk factor caused by addictive
behavior. It can cause damage in
several different ways. First, smok-
ing is dangerous because it deposits
nicotine, carbon, sulfur, and other
harmful chemicals into the lungs.
These harmful chemicals penetrate
deep into the smallest branches of
the lungs—the tiny air sacs. Inside
the air sacs, oxygen breathed in
from the air is supposed to pass
into the bloodstream. Air sacs that
are clogged from smoking cannot
deliver enough oxygen to the blood.
Damage to the mother’s blood in
turn causes damage to the fetus.
Through the bloodstream, the dam-
age from smoking spreads through-
out the body’s systems. Each system
becomes less able to produce the
substances it needs. For example,
smoking weakens the immune sys-
A woman should
get healthy before
she gets pregnant.
She should see
a doctor as early
in pregnancy
as possible.
tem, making it harder for the body
to produce antibodies to fight off
viruses and infections. Because
smoking damages so many parts of
the body, it is not always possible to
trace every path by which danger
from smoking reaches the unborn
infant. But statistics link smoking
to many of the worst health prob-
lems of pregnancy: miscarriage,
ectopic pregnancy, placental compli-
cations, low birth weight, and even
birth defects.
Substance Abuse. Alcohol,
cocaine, and other substance abuse,
like smoking, are risk factors
caused by addictive behavior.
Addictions have complex causes
that include home environment and
social pressures, in addition to
chemical reactions. For pregnant
women, the risks of substance
abuse extend to the unborn child.
For example, babies born to moth-
ers who used cocaine during preg-
nancy can be born addicted to the
drug. Mothers who drink alcohol
7
 Having Healthy Babies: The Science Inside
during pregnancy put their babies at
risk for fetal alcohol syndrome.
This is a combination of mental and
physical birth defects, including men-
tal retardation, heart problems, and
abnormal brain development
Teenage pregnancy. Teenage preg-
nancy is a risk factor with many
physical and social causes. Scientists
know that younger mothers are at
risk because so many health problems
occur more often among them. Women
under 20 are at greater risk for high
blood pressure, anemia, and prema-
ture labor during pregnancy. Teenage
mothers also have a higher chance of
having low birth weight babies. The
younger a mother is, the greater
the chance that her baby will not
weigh enough at birth.
It is not always possible to pinpoint
the causes of health problems among
teenage mothers. Studies show that
teenagers are more likely to have poor
eating habits and are less likely to
receive early prenatal care than older
mothers. Teenage mothers also tend
to gain less weight during pregnancy.
(A healthy, non-overweight woman
should gain between 25 and 35
pounds.)
Reducing risks: maternal
health before pregnancy
Fortunately, there are steps women
can take to reduce many of the risk
factors of pregnancy and childbirth.
For the best health, doctors recom-
8
mend these steps for all women
of childbearing age.
• Take at least 400 micrograms
(400mg) of folic acid every day. For
most women, this means taking a
multiple vitamin to supplement the
folic acid received from food. Since a
human embryo needs folic acid even
before the mother knows she is
pregnant, the USDA recommends
that all women of childbearing age
take folic acid.
• Eat a healthy, well-balanced diet
that is high in fiber and low in salt
and sugar.
• Learn your personal and family
medical histories. A woman’s med-
ical history can help predict and
prevent problems she might have
in pregnancy. The medical history of
the father can also be important.
Many risk factors for pregnancy are
medical conditions like heart dis-
ease and high blood pressure, which
can be passed down through both
sides of the family.
• Refrain from smoking, drinking
alcohol, and using cocaine and other
chemical substances.
• Refrain from having sex with multi-
ple partners and from other behav-
iors that spread sexually transmit-
ted diseases.
• Get regular medical and dental
checkups.
• Make sure you are immunized
against mumps and rubella and
keep other immunizations up to
date.
 Part 1: Who’s at risk in pregnancy?

For Wendy Hilliard, Prenatal

Exercise Scores a Perfect “10”

Wendy Hilliard is as comfort-

able stretching on mats in a
gym as she is sitting on a sofa
in her living room. After years
of triumphing in world-class
competitions in rhythmic gym-
nastics, she knows the rewards
of a steady exercise regimen
are more than gold medals
and cheers from an apprecia-
tive audience. That’s why,
when she became pregnant for
the first time at age 41, she
immediately began to think
about ways in which exercise
could continue to promote her
own good health – and that of
her unborn child. “I’ve been
an athlete my entire life, but
having a baby changes every-
thing. I wanted to be sure
that I did exercise that was
good for me and for my baby,”
said Hilliard.
“As it turns out, I did have to make adjustments to my routine, both in
terms of exercise and work.”
Before becoming pregnant, Hilliard engaged three to five times a week in
Bikram yoga, a demanding method in which a heated exercise area bol-
sters the difficulty of the workout. After years of training and competi-
tion, she loved the intensity of the workout; however, it was that intensity
that caused concern among her doctors. After considering the many exer-
cise options available to pregnant women, she switched to a weekly rou-
tine of prenatal yoga at the Prenatal Yoga Center in New York City, sup-
plemented by 3-mile walks.
Prenatal yoga, with its focus on Kegel exercises and proper breathing
techniques, is aimed at making pregnancy and childbirth easier on the
Hilliard, continued on next page 9
 Having Healthy Babies: The Science Inside

body—something any mom-to-be can appreciate. It also helps to reduce stress,

to boost energy, and to teach self-discipline.
For Hilliard, being disciplined has never been a problem. From first-hand
experience, she knows that hard work and training yield results. In 1978, she
became the first African American to represent the United States in rhythmic
gymnastics and she remained on the National Team a record-setting nine
times. A national and international gold medalist, Hilliard represented the U.S.
in more than 15 foreign countries and at three world championships.
Her personal and professional lives still reflect the energy and intensity level of
the city she calls home, New York, where she serves as managing director of
sports for NYC2012, an organization committed to bringing the Olympics to the
Big Apple.
As if that isn’t enough, she is also founder and president of the Wendy Hilliard
Foundation, an organization that has helped more than 5,000 New York inner-
city youth enjoy rhythmic gymnastics programs and its associated disciplines.
Yet, no matter how busy her schedule, Hilliard always makes time for exercise.
Like so many moms-to-be across the country and the world, she is enthusiastic
about her new form of exercise. “I love it. It’s a healthy, life-long activity that
really has a calming influence, and I am able to bond with the other moms-to-
be in my class.”
For Hilliard and other moms-to-be, prenatal exercise scores a perfect “10.”

10
Part 2: What is a
healthy baby?
Healthy conception
Conception takes place when a
male sperm cell fertilizes a female
egg. A woman is born with thou-
sands of eggs in her ovaries, and
usually only one of those eggs
matures per menstrual cycle. After
the egg is released, it travels
through the fallopian tube toward
the uterus. Sperm cells meet the
egg in the fallopian tube and fertil-
ize it. The fertilized egg then enters
the uterus and is implanted in its
wall, which begins a pregnancy.
(Sometimes, more than one egg
mature and become fertilized, which
leads to twins or other multiple
births.)
Healthy development
Most babies are born between 38
and 42 weeks after conception.
Obstetricians use the first day of
the last menstrual period plus 40
weeks as a formula for estimating
the expected delivery date. Medical
science divides a pregnancy by
trimesters—periods of about three
months each.
The first trimester. In a healthy
pregnancy, the fertilized egg moves
down the fallopian tube into the
uterus. The egg implants itself into
the wall of the uterus. This causes
certain hormones to be released,

Conception can take place only

within a very short amount of
time each month. A woman’s most
fertile time is in the middle of her
monthly cycle. This occurs about
two weeks from the first day of the
menstrual period, or between 12
and 14 days before the next men-
strual period is due. Once the sin-
gle-celled egg is fertilized, it imme-
diately begins to divide.

11
 Having Healthy Babies: The Science Inside
which signal the uterus to begin its
gradual change into a womb. By
three to four weeks after conception,
the fertilized egg has developed into
an embryo. The cells of the embryo
very rapidly divide into specialized
cells that will become the body’s
major systems. By nine or ten weeks
after conception, the embryo has
grown into a fetus.
Meanwhile, the mother’s body has
been changing to provide the fetus
with what it needs. By the end of the
first trimester, the place in the
uterus where the egg was implanted
has developed into the placenta.
For the rest of the pregnancy, the
placenta will nourish the fetus and
eliminate its wastes. A mucous plug
develops to seal off the mother’s
cervix, which creates a secure womb.
The second trimester. During the
second trimester, the baby further
develops the complex systems it will
need to survive on its own. Healthy
babies call more and more attention
to themselves during their fourth,
fifth, and sixth months in the womb.
Mothers and their doctors can hear
the baby’s heartbeat and determine
its sex and age.
Second-trimester babies begin mov-
ing their muscles, stretching, and
kicking. The skeletal, muscular, and
other systems grow stronger at an
ever-increasing rate. By the end of
month five, a healthy baby weighs
about one pound. It weighs two
12
pounds or more by the end of month
six. By the end of the second
trimester, the fetus still almost com-
pletely relies on the placenta for
nourishment and waste disposal. But
the baby has begun swallowing,
digesting, and breathing on its own.
The third trimester. During the
seventh month of pregnancy, the
fetus moves ten or more times every
hour. The mother feels most of these
motions. During the seventh and
eighth month, the baby will get into
birth position. The baby may move
around considerably before settling
down. The usual position is with the
head pointing down toward the birth
canal.
The unborn baby gains most of its
weight during the third trimester.
A healthy baby reaches about four
pounds by week 30 of pregnancy and
five pounds or more by week 35. The
baby is considered full term by week
37. The healthy baby will weigh
about 7.5 pounds at birth.
Healthy birth
In a healthy birth, the baby is born
with no complications in labor and
delivery and no harm to the baby.
The birth process is described in
detail in Part 3: “Health care during
pregnancy and childbirth.”
To first-time parents, a newborn
baby may not look especially healthy.
Its skin may have spots or patches of
waxy, flaky substances. Its head may
 Part 2: What is a healthy baby?

have a funny shape. The baby may

very well be red and wrinkled.
These are normal effects of child-
birth and need not cause alarm.
Birth attendants begin cleaning the
baby as soon as it is born. Babies
cannot see well at birth. An infant’s
vision takes some time to adjust to
the world.

These ordinary conditions of child-

birth usually clear up within a very
few days.

Healthy infancy and early

childhood
During its first month, the infant
will gradually stretch itself out
after being cramped so long in the
fetal position. After stretching out,
the infant becomes ever more inter-
active. Gradually the baby learns to
hold up its head, roll over, squirm
along, crawl, stand up, and then
finally walk. A baby’s skills develop
quickly in early childhood.

For more information about healthy

babies, see Part 3, “Health care dur-
ing pregnancy and childbirth,” Part
5, “Health care for infants and tod-
These illustrations show how the baby posi-
tions itself during labor for a routine vaginal
dlers,” and Part 6, “New research
birth. The baby descends headfirst into the on mothers and babies.”
mother's pelvis and shifts its head so the
smallest part will go through the birth canal
first.Then the baby turns from a sideways
position to one where its head faces its moth-
er's back. Finally the baby flexes its neck so
that doctors or medical attendants can guide
first the baby's head and later the rest of its
body out of the mother's womb.
13
 Part 2: What is a healthy baby?

Mother’s Milk—
A Recipe for Success
Morena Parada, a mother of three girls, understands that breastfeeding
can be a complicated issue for new moms. On one hand, researchers
point to a wide range of benefits that breastfeeding affords a baby—
from a stronger immune system to a higher I.Q. But for some women,
nursing can be difficult or even painful at first. Some women may also
worry about how people will react if they nurse their baby—especially
if they are the first person in their family or the only one among
friends who decides to breastfeed.

“For me, it came down to doing the best thing for my baby,” says
Parada, a 31-year-old mother from Alexandria, Virginia. “I think nursing
has helped my girls be healthier. They rarely get sick, and I think that
nursing is one of the reasons.”

Parada first made the decision to breastfeed eleven years ago when her
eldest daughter, Vicky, was born. Initially, the decision was made based
on convenience: Parada liked not having to worry about warming milk
in the middle of the night, toting bottles whenever she went out, or
paying for expensive formula. But there was an intangible benefit that
outweighed all others: the time spent nursing made her feel especially
close to her baby.

“It was our special time,” Parada said. “I would sing to her in Spanish,
and hold her as close to me as I could.”

When her second baby, Karina, now 4 1/2 years old, was born Parada
knew she would again breastfeed. And she did for 2 1/2 years.

Currently nursing her third child, Diana, age 1, Parada is a veteran of

breastfeeding and a vocal advocate. As part of her commitment to
keep her children healthy, Parada visits the clinic sponsored by the
Alexandria Neighborhood Health Services, Inc., a neighborhood-based
center that is geared toward the Hispanic population and dedicated to
making sure that women and children in need receive basic health care.
While at the clinic, Parada encourages expectant mothers to give nurs-

Recipe, continued on next page

15
 Having Healthy Babies: The Science Inside

ing a try, and for new mothers who are having a difficult time, she urges per-
severance.

Breastfeeding came easy to Parada, but she knows that is not the case for
everyone. “It is not always easy for new mothers. They complain about sore-
ness and sometimes the baby doesn’t take to it right away. It can be frustrat-
ing. I just tell the moms to give it a chance, but I understand that for some
mothers it’s really hard, especially when they don’t get support from others.”

Support is something Parada feels blessed to have. Her husband, Nicholas,

understands and appreciates what she is doing for their baby, and she finds
comfort in knowing that so many of her friends and relatives have made the
same choice.

In fact, research shows that Parada has a lot of company. A recent national
survey found that breastfeeding in the United States is at a record high, with
69.5 percent of new mothers starting out breastfeeding. Equally impressive is
that 32.5 percent are still nursing six months later.

For a variety of reasons, breastfeeding is not for every mother, but clearly
more and more women like Parada are viewing breast milk as a recipe for
their children’s success.

16
Part 3: Health care
during pregnancy
and childbirth
Recognizing pregnancy
As soon as conception begins, the
mother’s body begins to change. The
first unmistakable sign of pregnancy
is missing a menstrual period. A
sexually active woman who misses a
period should suspect pregnancy
first, even though there may be
other causes. Other early warning
signs include sore breasts, more fre-
quent urination, nausea and vomit-
ing (morning sickness), and
fatigue. A woman who suspects she
is pregnant might want to use a
home pregnancy test to confirm
her suspicions.
By the time the mother recognizes
the pregnancy, the embryo has prob-
ably been alive for two to four weeks
or more. A woman who thinks she is
pregnant should immediately
behave as if pregnant—stop smok-
ing, stop drinking alcohol and tak-
ing drugs, start eating right, and so
forth. She should seek prenatal care
as soon as possible.
Prenatal care
The first trimester. The first pre-
natal care consultation should take
place soon after the first signs of
pregnancy, preferably by the
end of the second month. A
mother will profit most from
the visit if she comes pre-
pared with the medical his-
tories of both herself and
the child’s father.
At the first visit, health
A mother
care professionals will ask questions receives
about the mother and father’s gener- health
al health and lifestyles. If necessary, counseling.
they will recommend changes.
The mother might be asked to
stop smoking, drinking alcohol,
and abusing drugs. The doctor
will ask what prescription and
over-the-counter drugs she is tak-
ing. Often the doctor will recom-
mend that she stop taking the
drugs and suggest alternative
treatments during pregnancy.
The doctor will also review the
mother’s medical history for dis-
eases or conditions that might be
risk factors in the pregnancy. When Babies need prenatal
the mother has a medical condition care during pregnancy
and postnatal care after
such as obesity, diabetes, or high
they are born.
blood pressure, the doctor will
advise her on how to control disease
during this critical time. The doctor
will test the mother for rubella
(German measles), HIV, and hepa- 17
 Having Healthy Babies: The Science Inside
HIV/AIDS and Pregnancy
• HIV (human immunodeficiency virus) causes
AIDS (acquired immune deficiency syndrome). AIDS
is passed on through sexual intercourse or exposure
to infected blood.
• Being infected with HIV (being “HIV positive”)
and having AIDS are risk factors for pregnancy.
They are associated with premature births and
other complications in pregnancy and with low-
birth-weight babies.
• Mothers can pass on HIV and AIDS to their
unborn infants. Without treatment, babies are
infected in 1 out of every 4 cases.
• The risk of infection to infants can be greatly
reduced by treating the mother with the drug AZT
(zidovudine) during pregnancy.
• To avoid blood exchange and contamination of
the baby during delivery, the doctor might recom-
mend delivery by caesarean section (c-section).
• Babies of mothers who have HIV or AIDS should
be tested soon after birth. New tests can identify
most infected babies by one month.
• Babies of mothers who have HIV or AIDS are at
continued risk from the virus during their first year
of life.
titis B—diseases that are especially
harmful to the embryo. A hemoglobin
test establishes how healthy the
mother’s blood is.
Whenever possible, the father’s med-
ical history is reviewed as well.
Looking at the genetic history helps
parents and their doctors decide
whether to perform genetic testing.
Some genetic conditions have a much
higher incidence among certain ethnic
groups. For example, people of
European descent have a higher rate
of cystic fibrosis. Tay-Sachs,
Canavan, and Gaucher’s diseases
18
are more common among Jewish peo-
ple. Sickle cell disease has a higher
incidence among African Americans.
Thalassemia occurs more often
among Asian Americans and those
of Mediterranean descent.
Prenatal health care professionals
will also advise mothers about diet,
nutrition, exercise, health environ-
ments, and other aspects of pregnan-
cy. They will set up a prenatal care
schedule for the rest of the pregnancy,
usually with monthly visits.
During the first trimester of pregnan-
cy, many women suffer discomforts
such as nausea, backaches, and
fatigue. Health care professionals
can help women alleviate these dis-
comforts. Good nutrition, exercise,
and other good health habits can also
help the mother feel better.
The second trimester. This is usu-
ally the most comfortable trimester
for both healthy babies and healthy
mothers. The discomforts of early
pregnancy usually go away. The baby
begins to grow, and the mother begins
gaining weight. A healthy amount to
gain during the second trimester is 3
to 4 pounds per month. Regular pre-
natal care should continue, with visits
to the doctor at least once a month.
By this time, the baby will have
grown enough for the mother and doc-
tor to hear the baby’s heartbeat. The
mother also feels the baby moving
inside her womb.
 Part 3: Health care during pregnancy and childbirth

In normal, healthy pregnancies,

health care providers can easily
monitor the baby’s progress without
high technology. They measure the
mother’s expanding body and check Warning Signs
the position of the fetus and the during
shape of the uterus. Vaginal exami-
Pregnancy
nation also shows how a pregnancy
is progressing. Doctors and nurses The American
ask questions about abnormal spot- Medical Association
ting or other symptoms the moth- recommends that a
pregnant woman see
er might be experiencing. Additional
Ultrasound scanning is often performed her doctor if she
blood and urine testing might also during pregnancy as a routine check-up. experiences any
be used to monitor health. The size of the fetus is assessed and any
of the following
abnormalities in growth or development
can be discovered. symptoms:
Under special circumstances, the
• Abdominal cramps,
doctor might also order more
contractions, or
advanced tests of the baby’s health. and to gain the right amount of other pain
Ultrasound tests, amniocentesis, weight. The total weight gain dur-
• Persistent, dull
chorionic villus sampling (CVS), ing pregnancy should be 25 to 35
backache
and alpha-fetoprotein screening pounds (for mothers of normal
• Pressure in the
help health care professionals moni- weight).
pelvis
tor the health of both the mother
• Leaks of blood or
and the baby. These tests are not During the third trimester the
other fluid from
routine. They are done if the mother mother might experience more dis-
the vagina
asks for them, or if the doctor comfort—such as frequent urination
• Pain or burning
thinks they are medically necessary. and constipation—as a direct
upon urination
At least two of the procedures— result of the growing baby.
amniocentesis and CVS—have some Backaches, swollen veins, and other • Headaches and
blurred vision
possible harmful side effects. problems might also develop. The
Women and their doctors or mid- mother should watch herself closely, • A fever with a
wives must weigh these risks when keep track of her symptoms, and temperature
over 100°F
deciding on this testing. discuss them with her obstetrician.
This is especially true for high-risk • A lower fever that
The third trimester. The last pregnancies. lasts for more than
a few days
trimester can get increasingly
uncomfortable for both the baby and This is the time when the woman • Extreme or sudden
the mother. The baby moves around and her doctor or midwife will be swelling of the
hands or feet
less, but restricts the movements of making decisions about how and
the mother more. It might become when the baby will be delivered.
necessary to have more frequent The medical condition of the mother
prenatal care visits. The mother or baby might lead the doctor to
should be careful to eat properly advise a caesarean section 19
 Having Healthy Babies: The Science Inside
(c-section). In a c-section, the baby
is delivered through a surgical inci-
sion of the uterus. For routine vagi-
nal birth, the mother might elect
to give birth without medications.
The mother might want to attend a
childbirth class to prepare for labor
and delivery. The father is also
encouraged to attend these classes.
Parenting classes help parents pre-
pare for feeding, changing, and clean-
Common Medical Conditions during Pregnancy
These conditions are usually not dangerous
and can be treated by changing your diet,
behavior patterns, or medications. However,
your doctor should monitor any of these con-
ditions, since they can lead to more serious
complications.
Morning sickness. Nausea and vomiting,
which usually occur during the first trimester.
Affects about half of all pregnant women.
Recommended treatments include eating
crackers or other bland food before getting
out of bed, eating several small meals a day,
avoiding foods that trigger nausea, drinking
plenty of fluids, and drinking tea or eating
foods that contain ginger.
Anemia. An inadequate level of hemoglobin
in the blood that is caused by too little iron or
folic acid in the diet. Symptoms include
fatigue, fainting, pale skin, heart palpitations,
and breathlessness. Treatment includes adding
iron-rich foods (leafy green vegetables, lentils,
cooked dry beans, and citrus fruits) to your
diet. This condition must be monitored careful-
ly to avoid more serious problems.
Edema. Swelling caused by extra fluid in the
mother’s body that is often brought on by
warm weather. Treatment includes putting
cold-water compresses on the affected areas,
avoiding salt, and elevating the legs and feet.
Sudden swelling of the face, legs, or feet
requires immediate medical attention.
Varicose veins. Painful and swollen veins,
especially in the legs, due to an increased vol-
ume of blood in the body. Afflicts about 20
20
ing the newborn infant. Health
experts recommend that parents get
as much training as possible while
they await the baby’s birth.
Nutrition, exercise,
and environment
Good prenatal care is up to the moth-
er as well as her doctors. The mother
percent of pregnant women. Treatment
includes staying off your feet and wearing sup-
port stockings and loose clothing.
Constipation. Slowed bowel activity, often
caused by pressure from the growing baby.
Treatment includes drinking 2–3 quarts of flu-
ids per day; getting moderate daily exercise;
eating fruits, whole grains, and vegetables;
and taking fiber formers or laxatives under a
doctor’s supervision.
Hemorrhoids. Enlarged veins in the anus,
often due to the increased pressure of consti-
pation. Treatment includes avoiding constipa-
tion, avoiding strain during bowel movements,
taking warm baths, and applying witch hazel
cream.
Heartburn. Burning sensation in the stomach,
often caused by the expanding uterus pushing
on the stomach. Treatment includes eating
smaller meals more often, eating more slowly,
avoiding greasy foods and coffee, raising the
head slightly during sleep, and taking simple
antacids under a doctor’s supervision.
Backache. Low-level pain in the lower back or
ligaments, caused by the weight of the grow-
ing baby. Treatment includes controlling
weight, eliminating strain, and getting moder-
ate exercise.
Disturbed sleep. Can be caused by all of the
above discomforts, as well as by stress, anxiety,
or depression. Treatment includes avoiding caf-
feine, avoiding large meals before bedtime,
and getting more exercise.
 Part 3: Health care during pregnancy and childbirth

will also need the cooperation of
everyone in her household.
Nutrition. A pregnant woman
should stop smoking or inhaling
second-hand smoke. She should
stop drinking alcohol. She should
stop using illegal drugs. She should
cut down on or eliminate sugar,
junk foods, fatty and salty foods,
and caffeine. Instead, she should
follow a well-balanced diet that is
rich in whole grains, fruits, and
vegetables.
Variety in nutrition is important in
order to make sure the mother and
baby get all the nutrients they
need. Pregnant women need protein
for cell growth and blood produc-
tion; carbohydrates for daily energy;
calcium for strong bones and teeth
as well as for muscle contraction
and nerve functions; iron for red
blood cell production; and fat for
stored body energy.
pregnant women should take vita-
min supplements to make sure all
their needs are met.
Exercise. Research shows that
exercise is not just safe for pregnant
women but beneficial. A woman
should consult her doctor, however,
before beginning her exercise pro-
gram. If she already exercises
regularly, she should clear her
routine with her doctor during her
first prenatal care visit. Jogging,
running, horseback riding, and
other exercises that require jerky,
bouncy movements are not recom-
mended for pregnant women.
Exercises to strengthen the pelvic
muscles are especially recommend-
ed for pregnant women. Kegel
exercises strengthen the muscles
that support the uterus, bladder,

The role of vitamins in promoting

health is also well known. Pregnant
women need vitamin A for healthy
skin, good eyesight, and strong
bones; vitamin C for healthy gums,
teeth, and bones and for healthy
absorption of iron; vitamin B6 for
healthy blood cell formation and to
help the body use proteins, fats, and
carbohydrates; vitamin B12 for red
blood cell formation and maintain-
ing nervous system health; vitamin
D for healthy bones and to aid in
absorbing calcium; and folic acid for
blood and protein production. Most
21
 Having Healthy Babies: The Science Inside

urethra, and rectum. During the last
trimester of pregnancy, mothers
should undertake exercise plans to
prepare for labor. Mothers can learn
such exercises at Lamaze or other
childbirth classes.
Safe environments. Clean house-
hold and work environments protect
the mother and baby from bacterial
infections during pregnancy and
early infancy. These are the most
critical times for the baby’s health.
The mother and other household
members should take extra care to
use high standards of hygiene.
Changing cat litter is unsafe for a
pregnant woman because cat feces
carry the bacteria toxoplasmosis.
Pregnant women and their babies
are more vulnerable to listeriosis
and other forms of food contamina-
tion. According to the Center for
Disease Control, pregnant women
are 20 times more likely than other
healthy adults to get listeriosis.
Changes caused by hormones are
thought to make pregnant women
more susceptible. Greater care than
usual should go into keeping kitchen
surfaces clean, washing food, and
cooking food thoroughly.
Health care experts are also becom-
ing more concerned about unsafe
work environments during pregnan-
cy. Pregnant women who work
should examine the hygiene stan-
dards in their workplace restrooms
and kitchen areas. Women should
also check for potential health haz-
ards, such as harmful chemicals,
that are used in the process of their
work. Women should discuss their
environmental safety concerns with
health care professionals.
Labor and delivery
In most pregnancies, labor begins
with a series of noticeable changes.

Pain Relief during Delivery

Each of these methods has advantages and drawbacks. The mother and her doctor or
midwife should discuss available options and make decisions as pregnancy advances.

Epidural. Insertion of a needle into the epidural space at the end of the spine.
This numbs the lower body.

Intravenous analgesic. Pain-relieving drug administered through a tube inserted

into a vein.

Lamaze (natural childbirth). Series of techniques for breathing and for stretching and
relaxing the muscles to aid in labor and delivery without medications.

Local analgesic. Pain-relieving drug administered locally through a needle inserted

into a muscle.

Pudendal block. A procedure that numbs the area around the vulva.
22
 Part 3: Health care during pregnancy and childbirth
The mother feels the baby descend-
ing into the pelvis. The mother
might begin to feel small, irregular
contractions of her uterus. Cramps
in the lower back are another sign
labor is approaching.
When these signs appear, the moth-
er and her health care providers
should make final plans for the
delivery. One important decision
to be made is what kind of pain
relief, if any, will be used during
the delivery.
The unmistakable signs of labor are
regular labor pains and breaking
water. A woman’s water sometimes
breaks first, but it usually happens
after labor pains have begun. The
pains come more frequently and
strongly as labor progresses. A
woman who has begun labor should
immediately set the delivery plan in
motion—call the doctor or midwife,
or get to the hospital or birth cen-
ter. The mother will be examined
The mother’s womb
and birth canal
prepare for delivery
and the fetus moves
into position for
birth when the
pregnancy has
reached “term”
in approximately Daily Food
9 months.
Portions during
Pregnancy
According to the
March of Dimes, a
pregnant woman’s
daily diet should
include the following:
and then admitted or sent home to • 6 to 11 servings of
remain on close watch, with emer- breads and other
gency plans in place. whole grains
• 3 to 5 servings
Most births are healthy. The moth-
of vegetables
er’s uterus contracts, which widens
the cervix. When the cervix is wide • 2 to 4 servings
enough, the mother begins to push. of fruits
The baby is thrust downward with • 4 to 6 servings of
each contraction, and then finally milk and milk
slides down into the birth canal and products
emerges head-first. The doctor and • 3 to 4 servings of
medical attendants guide the baby meat and protein
gently into the world. Attendants foods
quickly remove the mucus from the
• 6 to 8 glasses of
baby’s mouth and nose, and the
water, and no more
baby makes its first cry. Often the
than one soft drink
baby is placed immediately on its or cup of coffee per
mother’s stomach. The umbilical day to limit caffeine
cord is cut.
Several quick screening tests are
performed on the baby immediately
after birth, usually right in the
delivery room. Attendants weigh
and measure the baby. They per-
form a simple visual test and give
23
 Having Healthy Babies: The Science Inside
the infant an Apgar score, which
measures the baby’s overall respon-
siveness. They wrap the baby in a
blanket for warmth. They give the
baby an injection of vitamin K, which
prevents bleeding. They also use eye
drops that contain an antibiotic, to
clean out possible infections from the
birth canal.
Most births that are not rou-
tine also result in healthy
infants. For example, a
breech birth, in which the
baby emerges feet first,
makes for a more complicat-
ed delivery. But when mod-
ern delivery procedures are
followed, there is usually no
harm to the baby. Birth by
caesarean section (c-section)
is a safe alternative in com-
Most deliveries plicated deliveries.
are routine and
safe for both
mother and
For the baby, the medical procedure
baby. immediately after birth by c-section
is usually the same as in a routine
vaginal delivery. However, the
medical staff will be alert for possible
complications and prepared to offer
emergency care to both mother and
infant. For example, a birth by
c-section might require the temporary
use of an incubator. Delivery by
surgery will also mean a different
recovery process for the mother.
Postnatal care
Most new mothers and their infants
go home after only a few days in the
24 hospital. Recovery from even a
healthy, normal pregnancy and deliv-
ery takes several weeks. Both mother
and baby need adequate diets, plenty
of rest, and freedom from stress.
Feeding the newborn infant.
Whenever possible, mothers should
breastfeed their infants right after
birth. To encourage breastfeeding,
many health care centers offer
breastfeeding classes, beginning very
late in pregnancy. Mothers who can-
not breastfeed can be reassured that
bottle feeding is also a healthy alter-
native. If a c-section has been per-
formed or there have been complica-
tions during delivery, breastfeeding
might have to be delayed a few hours
or days. In some cases, bottle feeding
is actually healthier for the baby.
For example, the mother might be too
tired to nurse, or she may be using a
drug that enters her breast milk.
The decision of whether to breast-
feed or bottle feed depends on the
mother’s individual circumstances.
Recovery for the newborn infant.
A newborn infant spends most of the
first few days after birth sleeping and
recuperating. The newborn is quite
fragile, especially in the neck and
spine. It is usual for babies to lose
weight during the first few days after
birth, because they are losing extra
body fluids. At about five days old,
the healthy infant starts to regain
weight, reaching the original birth
weight about ten days after birth.
After that, the baby gains weight
quite rapidly.
 Part 3: Health care during pregnancy and childbirth

Snuffing out SIDS

It seems like children have been
tagging around after Amanda Sue
Bordeaux all her life – and Bordeaux
couldn’t be happier about it. As the
third-oldest in a family of nine kids,
Bordeaux learned at a young age how
to comfort and care for babies. When
she was in high school, she ran a tutor-
ing and nutrition program for younger
children after school. Now that she’s a
grandmother, Bordeaux isn’t slowing
down; she runs an in-home daycare
program with 12 to 15 children.

“I think my daycare career really started

when I was 10 years old,” laughed Bordeaux as she chased her two-year-
old grandson around her home in Rosebud, South Dakota.

But a moment later, she turned serious. Bordeaux, who is Native American,
has become increasingly worried about the number of babies on her reser-
vation who have died in their sleep from Sudden Infant Death Syndrome,
or SIDS.

“Recently there have been a lot of baby deaths, and I’m kind of baffled
about it,” Bordeaux said. “Because I take care of a lot of kids I hear about
it from different people. Fortunately I’ve never had anything happen to a
child in my care, but one of my fellow daycare providers had taken care of
a child who passed away from SIDS recently.”

That’s why Bordeaux, who is a member of the Comanche tribe, attended a

recent two-day conference on SIDS held in Rosebud, which drew experts
from as far away as Washington, D.C. The conference was both scary and
reassuring, said Bordeaux. It frightened her to realize that South Dakota is
in the region of the country that has the highest rate of SIDS. But she felt
better knowing that parents and caregivers can do many things to
decrease the chance that SIDS will strike their babies.

The conference was really a brainstorming session, said Bordeaux. “The

main objective was how we can get the word out to the Native American

SIDS, continued on next page

25
 Having Healthy Babies: The Science Inside

people about SIDS being at the highest rate in our area and how we can pro-
mote awareness of ways to prevent it.”

Although Bordeaux already knew the importance of putting babies to sleep

on their backs, rather than on their stomachs, and of keeping soft bedding
and stuffed animals out of the crib until a child turns one year old, other tips
she learned at the conference came as a surprise.

“I didn’t realize there was an association with cigarette smoking and SIDS,”
she said. “Everybody talks about how you shouldn’t smoke around kids, but
I never realized smoking could be so bad for kids even before they’re born.”

So now Bordeaux warns pregnant women on her reservation not to smoke—

and not to stand too close to anyone else who is smoking either.

“My own daughter is due with her baby in July, and she didn’t even know
that,” said Bordeaux.

When that baby arrives, it’ll be grandchild number three for Bordeaux – but
she sometimes feels as though she’s a grandmother to hundreds of kids. Just
recently, a young woman who once attended Bordeaux’s in-home daycare
telephoned and asked Bordeaux to come with her to the hospital: It was time
for her to deliver her own baby.

Bordeaux can’t wait to sing that new little baby girl a lullaby – before she puts
the baby down to sleep on her back, of course.

26
Part 4: Complications
of pregnancy
Infertility
Infertility is the inability to con-
ceive children. Doctors think of cou-
ples as infertile if they are not able
to conceive children after a year of
sexual intercourse without birth
control.
Infertility has many causes.
Problems with the male reproduc-
tive system occur in about 30 per-
cent of infertility cases. Up to 70
percent of infertility problems origi-
nate in the female reproductive sys-
tem. Known causes of infertility for
both men and women include emo-
tional stress, malnutrition, obesity,
cancer, abuse of alcohol and drugs,
smoking, and certain medical condi-
tions (diabetes, thyroid disease,
HIV/AIDS, and others). Female
infertility is most often caused by
diseases of the reproductive system,
such as pelvic inflammatory
disease and endometriosis.
Medications and treatments for
infertility are as varied as the caus-
es. Intense screening and diagnostic
tests might be necessary to estab-
lish the source of the problem.
The woman might be treated with
fertility drugs. These are medica-
tions, often hormones, which
regulate or bring about ovulation.
When a disease such as endo-
metriosis has caused permanent
damage to the reproductive system,
in vitro fertilization might be
used. In this procedure, the egg
Common Pregnancy Complications
The Centers for Disease Control lists the most
common complications of pregnancy, which
include:
• ectopic pregnancy
• depression
• high blood pressure
• infection
• complicated delivery
• diabetes
• premature labor
• hemorrhage
• miscarriage
• excessive vomiting
• need for a caesarean delivery
The CDC also lists the leading causes of maternal
death:
• hemorrhage
• blood clots
• high blood pressure
• infection
• strokes
• amniotic fluid in the bloodstream
• heart muscle disease
27
 Having Healthy Babies: The Science Inside

and sperm are joined in the laborato- Ectopic pregnancy. An ectopic

ry and then transferred to the uterus.
Miscarriage and other
pregnancy loss
Miscarriage. A miscarriage is the
loss of an unborn child during the
first 20 weeks of a pregnancy. It often
occurs before the mother learns she is
pregnant. Between 15 and 20 percent
of known pregnancies end in miscar-
riage. Its medical term is sponta-
neous abortion.
pregnancy, also called a tubal preg-
nancy, is one in which the fertilized
egg develops outside the uterus. Most
of the time (about 95 percent), the egg
settles in the fallopian tube. The egg
might also become implanted in the
cervix, abdomen, or ovaries. As an
ectopic pregnancy goes on, the grow-
ing embryo or fetus can burst the
organ that contains it. The rupture
causes internal bleeding and puts the
mother in danger of her life. Most
ectopic pregnancies do not develop
into live births.

Miscarriage is almost never caused by

Ectopic pregnancies occur in about 2
exercise or sexual intercourse. In
percent of all pregnancies. Early
most miscarriages, the fertilized egg
detection of an ectopic pregnancy can
does not develop normally. The abnor-
save the mother’s life. The warning
mal development is due to genetic fac-
signs include vaginal bleeding, fol-
tors. Miscarriages are also associated
lowed by worsening pain in the lower
with risk factors in the mother’s
abdomen. There might also be shoul-
health, such as smoking, alcohol and
der pain, dizziness, nausea, and
illegal drug use, chronic disease, and
vomiting.
older age. A condition called an
incompetent cervix is responsible
Molar pregnancy. A molar preg-
for some repeated miscarriages.
nancy is one in which the placenta
Women who have already had several
grows abnormally. The baby may not
pregnancy losses are at greater risk
form at all, or be unformed and
for miscarriage in the future.
unable to survive. The rate of
However, miscarriages also take place
frequency is about 1 in 1,000
in low-risk pregnancies. They are usu-
pregnancies.
ally not preventable.
Ultrasound technology (sonograms)
Warning signs of a miscarriage
can help detect molar pregnancies
include vaginal spotting or bleeding,
early. Surgery is needed to remove the
losing fluid or tissues from the vagi-
molar tissue. After the surgery, the
na, abdominal pain, and cramping. A
woman is monitored for a year for
woman with those symptoms should
choriocarcinoma, a cancer that
call her health care providers and
can develop in any remaining molar
seek help immediately.
28 tissue.
 Part 4: Complications of pregnancy

Warning signs of molar pregnancy

include vaginal bleeding a week
after a missed period, abdominal
cramping, severe nausea and vomit-
ing, and high blood pressure.

Stillbirth. A stillbirth takes place

when a baby dies in the womb after
the 20th week of pregnancy. This
happens in about 1 in 200 pregnan-
cies. Only about 1 in 7 stillbirths
takes place during labor and deliv-
ery. Many stillbirths happen with-
out warning in an otherwise
healthy pregnancy. Women with
high blood pressure and diabetes
are at higher risk.

A mother’s first notice of a stillbirth

is that the baby stops kicking and
moving around. Bleeding from the
vagina is another sign. A stillbirth
is often diagnosed by ultrasound.
Doctors induce labor after the diag-
nosis in order to save the health of
the mother. The baby and placenta
are examined. However, the cause
of death in a stillbirth cannot
always be determined.
Diabetes
Diabetes is a disease that prevents
the body from digesting sugars
and starches properly. Women who
have diabetes before they are
pregnant have more risk factors
for pregnancy.
In vitro implantation of embryo into uterus.
Type 1 and Type 2 diabetes.
Type 1, or insulin-dependent, dia-
betes is caused by the failure of the
pancreas to produce the hormone
insulin. Young people usually
develop this form of diabetes before
age 20. Patients with Type 1 dia-
betes require daily insulin shots.
Type 2, or noninsulin-dependent
diabetes, is brought on by overeat-
ing and poor diet and is associated
with obesity. This type of diabetes
can often be brought under control
with proper diet, weight loss, and
oral medication. Both Type 1 and
Type 2 diabetes are risk factors for
pregnancy. Pregnant women who
are diabetic may need to discontin-
ue or change their medications to
avoid harm to the baby. 29
 Having Healthy Babies: The Science Inside
Gestational diabetes. Gestational
diabetes occurs during pregnancy
and goes away after the pregnancy is
over. Between 3 and 5 percent of preg-
nant women in the United States
experience this complication. In gesta-
tional diabetes, the pregnant woman’s
system is unable to properly regulate
the release of insulin. As the placenta
and fetus grow, more insulin is need-
ed, until the pancreas can no longer
make enough insulin to keep up with
demands.
There are many risk factors associat-
ed with gestational diabetes, such as
obesity, a family history of diabetes,
having too little amniotic fluid, or
having a history of very large births,
stillbirths, or births with birth
defects. Older mothers are also at
greater risk. But many women with-
out those risk factors also develop
gestational diabetes.
Doctors recommend that all pregnant
women be tested for gestational dia-
betes. Women who are diagnosed with
this condition will be asked to help
control their blood sugar levels with
diet. The health of the fetus and
mother will be monitored to reduce
complications during later pregnancy
and childbirth. Health problems due
to gestational diabetes are manage-
able and preventable.
30
High blood pressure
High blood pressure (or hyperten-
sion) can exist before pregnancy or
develop during pregnancy (gestation-
al hypertension). Both types can
lead to health problems and complica-
tions during pregnancy. Hypertension
can damage the mother’s kidneys
and other organs. A disease associated
with high blood pressure is pree-
clampsia. Preeclampsia can lead to
an even more serious condition,
eclampsia. Problems related to high
blood pressure occur in 6 to 8 percent
of pregnancies in the United States.
Doctors may advise a pregnant
woman with high blood pressure to
control her weight, increase exercise,
and make other dietary and lifestyle
changes. Pregnant women should tell
their doctors about blood pressure
medications they are taking.
Preeclampsia is characterized by a
combination of high blood pressure
and increased protein in the mother’s
urine. Increased protein in the urine
might be the result of kidney prob-
lems. The kidney problems could be
the result of the mother having high
blood pressure or diabetes before
pregnancy.
Preeclampsia occurs more frequently
in mothers over 40 and under 20,
obese mothers, and mothers with
diabetes, kidney disease, rheuma-
toid arthritis, lupus, or scleroder-
ma. It is also more common
during multiple births.
 Part 4: Complications of pregnancy

Preeclampsia prevents the placenta Stress, anxiety,

from getting enough blood. The pla-
centa therefore cannot nourish the
baby adequately. This can cause low
birth weight and other problems.
Warning signs of preeclampsia
include severe headaches, excessive
swelling of hands and feet, dimin-
ishing urine, blood in the urine,
vomiting, double or blurred vision,
fever, pain in the abdomen, rapid
heartbeat, and dizziness. Special
prenatal care is needed.
Fortunately, only a small percent-
age of women with preeclampsia
develop eclampsia, a serious condi-
tion characterized by seizures.
Hospitalization late in pregnancy
might also be required if the doctor
feels that eclampsia is a threat.
and depression
Mental health during pregnancy is
another issue that concerns health
care professionals. Recent studies
have shown that depression, stress,
anxiety, and other mood disorders
strike many mothers, both during
and after pregnancy.
Stress can contribute to emotional
and mental problems during preg-
nancy. Normal worries of parents,
such as where to find the extra
income to care for the new baby, can
put stress on the mother. The dis-
comforts of pregnancy can also lead
to stress. Research suggests that
stress is harmful because it releases
a hormone that can trigger contrac-
tions of the uterus. Stress also caus-
es higher blood pressure, elevated

Symptoms of Postpartum Depression

The U. S. government’s Office on Women’s Health recommends that mothers who
exhibit these symptoms seek professional help:
• Restlessness, irritability, or excessive crying
• Headaches, chest pains, heart palpitations, numbness, or hyperventilation
• Inability to sleep, extreme exhaustion, or both
• Loss of appetite and weight loss
• Overeating and weight gain
• Difficulty concentrating, remembering, or making decisions
• Excessive concern or disinterest with the new baby
• Feelings of inadequacy, guilt, and worthlessness
• Fear of harming the baby or oneself
• Loss of interest in sex and other normal activities

31
 Having Healthy Babies: The Science Inside
heart rate, and other negative physi-
cal reactions. Indirectly, stress can
cause harm by leading to smoking,
drinking, or not eating well.
Mood swings and feelings of depres-
sion also trouble many pregnant
women. Changes in the body’s
hormones are the cause of some
of these emotional changes. Health
care professionals can recommend
a variety of techniques for reducing
stress and improving mental health.
Deep breathing, meditation, and
other relaxation techniques help
many women. Support groups and
childcare classes relieve anxieties
about pregnancy.
Postpartum depression among
mothers who have just given birth
ranges from mild to severe. About 10
percent of pregnancies result in post-
partum depression. An even more
serious mental illness, postpartum
psychosis, may affect as many as
1 in 1,000 new mothers. Women who
suffer postpartum depression exhibit
a wide variety of physical symptoms.
Studies have linked these symptoms
32
to hormonal changes and to drops in
thyroid levels. There are significant
links between postpartum depression
and pre-existing mental disorders, as
well as to extreme stress and abuse
at home. Although the exact causes
of postpartum depression are not yet
known, health care professionals do
know about medications and other
treatments that alleviate the condi-
tion. Pregnant women and new
mothers are urged to seek profession-
al help and to discuss their feelings
openly with their nurses and doctors.
Postpartum depression, like all forms
of depression, is treated with combi-
nations of counseling and drug
therapy.
Premature labor
and childbirth
The best chance for a healthy baby is
a full-term pregnancy. The baby needs
those last weeks in the womb to
develop its lungs for breathing on
their own. Important brain growth
also occurs during the last weeks of
pregnancy. A full-term delivery hap-
pens about 40 weeks after the moth-
er’s last menstrual period. Ten to
eleven percent of babies are born pre-
mature—they are delivered 3
or more weeks before the due date.
Premature labor. Premature
labor can take place at any time dur-
ing the last four months of pregnancy.
Early labor poses some health risks to
the mother. But doctors sometimes
induce early labor in mothers, in
 Part 4: Complications of pregnancy
cases where the health dangers are
greater if the pregnancy continues.
In general, the later in the pregnan-
cy the mother gives birth, the better
her baby’s chances will be for
healthy survival.
Not all premature labor ends in
immediate delivery. In many cases,
doctors are able to stop premature
contractions. Extra fluids, bed rest,
and medications such as muscle
relaxants are used to stop contrac-
tions. Extra care, even hospitaliza-
tion, may be required for the rest of
the pregnancy. If premature labor
cannot be stopped, doctors give
mothers medications that prepare
the baby for birth. They might also
give mothers medications that stop
labor briefly, to make a safer pre-
mature delivery possible.
Premature delivery. Risks to the
mother during premature delivery
are higher than for full-term births.
The higher risks are partly due to
differences in procedure. For exam-
ple, premature births are often
medical emergencies. Early births
more often involve c-sections and
other extra procedures. Medications
that stop contractions can also
cause fluid to build up in the lungs,
which can complicate delivery.
In spite of the higher risk, however,
most premature deliveries are phys-
ically safe for the mother.
Babies are at much higher risk
than mothers during and after
Premature Labor: Signs and Causes
Pregnant women should stay alert for these warning signs
of premature labor:
• vaginal spotting or bleeding
• abdominal cramps like menstrual cramps
• low back pain
• feeling pressure on the pelvis
A woman should seek medical help as soon as she experiences
any of the above warning signs.
Medical emergencies that require a doctor immediately are:
• regular contractions of the uterus
• watery discharge from the vagina
Only about half of the cases of premature labor can be
explained. Known causes of premature labor include:
• a rupture in the amniotic sac
• infections and disorders of the uterus, cervix, or urinary
tract
• certain chronic diseases, including high blood pressure,
kidney disease, diabetes, and hyperthyroidism
• previous premature deliveries
• smoking, alcohol, and drug use by the mother
• malnutrition in the mother
• congenital defects in the baby
premature delivery. Premature
babies usually need perinatal
care to survive.
Very premature babies will require
months in intensive care in the
hospital. Mothers who give birth
prematurely are at high risk for
postpartum depression and may
need medication, counseling, or
both.
33
 Having Healthy Babies: The Science Inside

Neonatal NICUs are increasingly successful in

intensive care
Perinatal care is
the medical care of
premature infants
who cannot survive
on their own. Such
care takes place in the
hospital, in neonatal
intensive care units
(NICUs). (Neonatal
means newborn.)
NICUs also care for
full-term babies who
develop problems
after birth.
Knowing
the risk Most babies in NICUs are kept in
factors can
incubators. The incubator serves as
help predict
and prevent an artificial womb for the premature
complications child. It keeps the baby warm and
of pregnancy free of infections. Depending on its
and childbirth.
age, the baby will receive intra-
venous feeding, be fed through
a tube in the nose, or be fed with
a bottle. The baby’s blood pressure,
heart rate, breathing, and tempera-
ture are carefully monitored.
Infants stay in NICUs until they no
longer need continuous hospital care.
To go home, a baby must have a sta-
ble temperature, be able to nurse,
and be gaining weight. Such infants
will need special care at home. They
often cannot breastfeed. Infants born
prematurely need closer monitoring,
more frequent doctor’s visits, and
more medications than full-term
infants.
keeping even very premature babies
alive. However, very young premature
babies (between 23 and 25 weeks old)
have higher death rates and higher
risks of serious medical problems.
Only 30 to 50 percent of babies born
at 23 weeks survive. Babies 25 weeks
old have a 60 to 90 percent survival
rate.
Very young premature babies who
survive are at high risk. About two-
thirds of premature babies who weigh
less than 2 pounds at birth have
developmental problems. Half of those
(one-third of the total) are serious
medical problems, such as cerebral
palsy, seizures, and hydrocephalus
(too much fluid in the brain). There
may also be lasting nerve damage.
The other half (one-third of the total)
are less serious chronic health prob-
lems, including slower growth rates,
increased incidence of infections,
vision and hearing problems, and
slower rates of learning.
Older premature babies have higher
chances of surviving and growing up
healthy. However, all premature
babies are at high risk for low birth
weight. Babies who weigh less than
5 pounds, 8 ounces are at higher risk
for medical complications than babies
who are born at normal weight
(7–8 pounds).

34
 Part 4: Complications of pregnancy

The Root Cause of

Better Learning
Barbara Bowman knew she’d found her
life’s calling when she walked into a nurs-
ery school and looked into the bright eyes
of young children.

At the time, Bowman was a college stu-

dent, and visiting the nursery school was a
requirement for a school course. But
Bowman discovered that even after she’d
completed the class, she didn’t want to say
good-bye to the kids.

“I was fascinated with how interesting

young children were, even babies,” she says. “I was pretty good at talking
to them, responding to them. They liked me and I liked them.”

Now Bowman stands as one of the nation’s foremost experts in early

childhood education. During her 50-year career, she has served on White
House panels, national science advisory boards – and she even has a street
named after her in her hometown, Chicago. But ask her about her most
important achievement, and you can hear the pride in her voice shine
through as she talks about her own daughter and 17-year-old grand-
daughter.

As a parent and an educator, Bowman knows every mother and father

can take simple steps to set the stage for a lifetime of better learning for
their children. Just because babies don’t yet talk doesn’t mean they’re not
capable of learning. In fact, research shows the most rapid and significant
growth of a person’s brain occurs during the first year of life.

Parents don’t need flashcards or special kinds of music to stimulate their

babies’ brains. In fact, the most important thing they can do is spend time
playing with and talking to their children, Bowman says.

“We know when infants are stimulated pleasantly – not too much, not
too little – it does make them smarter,” Bowman says. “Letting babies

BETTER LEARNING, continued on next page

35
 Having Healthy Babies: The Science Inside

handle things, playing with them, and giving them body rubs are examples
of things that children get pleasure from that are good for them and help
make them smart.”

Bowman says that while reading to children is important, parents who are
unable to read well themselves might shy away from books. There’s a simple
solution, she says: Take your children to story time at the local library and
encourage them to retell stories they have heard.

Bowman has seen firsthand how the challenges of preparing children to

learn are felt around the world. After she married, she traveled with her hus-
band to Iran and worked with children in orphanages and public schools and
spent time with tribes. After returning to Chicago, she helped form the
Erikson Institute, which trains daycare directors, teachers of young children,
and other child-centered professionals to enter the workforce.

Bowman knows that just as strong, healthy roots allow a tree to stretch
toward the sky, giving young children the things they need early on lets
them soar to their full potential. And to a child, love is just as important as
food to eat and air to breathe.

“The early experience of being well taken care of and having somebody
enjoy being with you and all those very simple things are what builds a
child’s capacity to love,” Bowman says.

With those kinds of roots, the sky can be the limit for any child.

36
Part 5: Health care of
infants and toddlers
Caring for an infant
at home
Feeding the new baby. Breast
milk or infant formula is the main
source of nutrition for a baby in its
first year of life. The advantages of
breastfeeding infants are well
established. Breast milk from a
healthy mother strengthens the
baby’s immune system, provides the
baby with complete nutrition, and is
easier than formula for the infant to
digest.
Baby’s Milk
The alternative to breast milk is an For most babies, the healthiest food is their mother’s milk.
Here are some of the advantages of breast milk from a healthy
infant formula. The mother
mother:
should consult health care profes-
• Strengthens the infant’s immune system
sionals in choosing the best type
• Provides complete nutrition for the infant
and brand for the baby’s specific
• Is easier for the infant to digest
needs. Infant formulas must be pre-
• Helps low birth weight babies gain weight faster
pared and stored safely to protect
• Costs much less than infant formula
the baby’s health.
Infant formula is also healthy for infants when it is prepared
and stored correctly. Here are some rules for safe bottle
Babies can start eating solid food feeding.
when they are 4 to 6 months old. • Sterilize all bottles and nipples before use.
Solid food should be introduced lit- • Formula should be mixed only with water that has been
tle by little. The baby’s specific diet boiled. Boil the water for at least two minutes. After the
should be planned with the help of water has cooled to warm, mix with the formula.
health care professionals. Doctors • Mix the formula in the correct proportions.
might recommend vitamin supple- • Keep prepared formula in the refrigerator. Use within 48
ments or dietary changes for under- hours.
weight or overweight infants. • Warm the refrigerated formula before feeding the baby.
Whole milk is not good for infants. It should not be part of a
baby’s diet until sometime around the first birthday. 37
 Having Healthy Babies: The Science Inside
Keeping clean. Newborn babies
should get warm sponge baths until
the umbilical cord falls off and the
baby is otherwise recovered from
childbirth. Cleanup after each diaper
use and daily sponge baths remain
the safest forms of bathing until the
baby can hold its head up on its own.
Bathing a newborn in a sink or tub
should be done only with extreme
care, preferably by two adults.
The baby’s entire environment should
be kept as clean as possible. People
who handle the baby should observe
good hygiene habits, espe-
cially washing the hands
thoroughly after using the
bathroom and after chang-
ing the baby’s diapers.
The baby’s toys should be
sterilized or washed fre-
quently.
Keeping safe. Parents
have the responsibility to
provide a safe home envi-
ronment. This is more of a
challenge as the baby
becomes more able to
move on its own. A house
should be “baby-proofed”
Babies use all their to eliminate accident risks, such as
senses to explore open electrical plugs and household
the world, so it is
important to baby-
chemicals (most cleaning products).
proof a house to Playpens and other safe areas can
prevent them from also reduce danger. Consumer
putting dangerous
guidelines should be followed in buy-
things in their
mouths. ing car seats, cribs, playpens, walk-
ers, and other baby furniture and
toys.
38
Postnatal medical care
Regular visits to doctors and clinics
help keep babies healthy. It is com-
mon for the baby to have two doctor’s
appointments in the first month of
life and one visit a month for the first
year. High-risk infants may require
more frequent visits.
During visits, health care profession-
als monitor the baby’s growth and
discuss any concerns the parents
may have about the baby’s health.
They can help the parents learn to
recognize common childhood ailments
and how to treat them. Doctors also
recommend that infants and toddlers
be immunized against common child-
hood diseases.
Risks to infant health
A healthy baby is born with a strong
immune system, which gets even
stronger if the baby is breastfed by a
healthy mother. With good nutrition
and a healthy, caring environment,
most infants stay healthy and grow
up normally. There are, however,
some medical conditions that threaten
infants, especially infants who are
already at risk.
Sudden infant death syndrome
(SIDS). Sudden infant death
syndrome (SIDS) is the sudden and
unexplained death of a baby under
one year of age. The cause is not
known. However, certain risk factors
are known. SIDS occurs more often
when mothers smoke during or after
 Part 5: Health care of infants and toddlers
pregnancy, or if the baby is born
prematurely or with low birth
weight.
Doctors have an important new
message to spread: babies who sleep
on their backs have a significantly
lower rate of SIDS than babies who
sleep on their stomachs. Putting the
baby to sleep on its back dramati-
cally reduces the risk of SIDS.
Failure to thrive. Failure to
thrive is the term used when a
baby is consistently behind normal
growth for its age group. Prema-
ture, low birth weight, and under-
nourished babies are most likely to
suffer from it. Failure to thrive can
result from many different causes.
The warning signs include being
underweight and having low levels
of response, a high rate of infections
and childhood illnesses, and learn-
ing disabilities.
Shaken baby syndrome. Shaken
baby syndrome is a severe head
injury that occurs when a baby is
shaken hard enough to cause the
baby’s brain to bounce against his
or her skull. Sometimes, parents or
other caregivers may shake a baby
out of frustration, thinking that it is
harmless. Shaking a baby, however,
can be just a dangerous as hitting
or other forms of abuse. The bounc-
ing of the brain against the skull
may cause bruising, swelling, and
bleeding of the brain, which may
lead to permanent, severe brain
damage or death.
The warning signs of shaken baby
syndrome may include changes in
behavior, irritability, tiredness, loss
of consciousness, pale or bluish
skin, vomiting, and seizures.
Reducing the
Risk of SIDS
It is important for parents to be on The National
the alert for any signs of illness or Institute of Child
unusual behavior in infants and Health and Human
Development recom-
babies. Even small concerns should
mends the following
be brought to a doctor’s attention
during regular medical checkups. to help lower the
risk of sudden infant
death syndrome:
Health in infancy and early • Place the baby on
his or her back to
childhood sleep.
Babies who are one to three months • Place the baby on
old become ever more interactive. a firm mattress.
They discover their parents and • Remove all pillows,
other familiar faces. They learn to fluffy blankets,
smile and make noises in response and stuffed toys
to other people. They learn to reach from the crib.
for and grasp objects. They play • Keep the baby’s
with their toes. head and face
uncovered during
New babies continue to kick, sleep.
stretch, and develop stronger bones • Do not smoke
and muscles during their fourth before or after the
through seventh months. Gradually birth of the baby.
the baby learns to hold up its head, • Keep the baby
roll over, squirm along, and start to from overheating
crawl. He or she responds more and during sleep.
more to toys, starts to imitate adult
movements—and keeps working
toward crawling and walking.
Babies make a huge amount of
progress in their intelligence, mobil-
ity, language skills, and interactions
with others as they approach their
first birthdays. Between their
39
 Having Healthy Babies: The Science Inside

Warning Signs in Infancy and Early Childhood

The American Medical Association lists • Cannot control hands
these signs as warnings that a baby is not • Says no simple words (“mama,” “dada”)
developing normal skills: • Does not use gestures, such as waving
or shaking head
• Does not point to objects or pictures
1 to 3 months
• Cannot support its own head
By the end of 3 years
• Cannot hold its head up 45 degrees
• Falls frequently
• Cannot grasp or hold objects
• Has difficulty with stairs
• Cannot make fist
• Drools persistently
• Does not press down legs when feet are
• Has very unclear speech
on a flat surface
• Cannot build a tower of more than
four blocks
4 to 7 months
• Has difficulty manipulating small
• Has stiff or tight muscles
objects
• Feels extremely floppy
• Cannot copy a circular shape
• Does not use one side of the body
• Cannot communicate in short phrases
• Favors one arm or leg
• Does not get involved in “pretend” play
• Cannot get objects to his or her mouth
• Fails to understand simple instructions
• Cannot roll over by 5 months
• Shows little interest in other children
• Cannot sit when supported by 6 months
• Has extreme difficulty in separating
• Cannot control head adequately at 7
from mother
months
• Does not reach for objects by end of 7 Source: Adapted from American Medical Association,
months Caring for Baby and Young Child, Bantam, 1999.
Online at www.medem.com.

8 to 12 months
• Cannot crawl
• Cannot stand when supported
• Does not use both sides of the body
equally

eighth and twelfth months, babies also be learning to climb stairs or to

learn to crawl. They love doing it and
get better and better at it. They also
learn to pull themselves up.
Most babies start to walk by their
first birthday and improve their walk-
ing in the months that follow. As the
child masters walking, he or she may
bend over and stand up again without
falling.
A baby’s skills (what the baby can do)
develop quickly in early childhood.
Health care and early childhood
experts use skills to mark the
progress of children’s mental and

40
 Part 5: Health care of infants and toddlers
physical health. Such guidelines
from the experts are very useful in
understanding the general progress
of a healthy baby’s growth.
However, the guidelines should
never be read as absolute. Health
care professionals know that
healthy babies develop at different
rates. They can help mothers,
fathers, and other caregivers give
the baby the best possible environ-
ment for healthy growth.
Helping a baby learn brings rich rewards.
Smart babies: Learning
through play
New research shows that a baby’s
brain starts developing much earlier
than experts used to think. Parents
today are encouraged to start teach-
ing their infants soon after birth by
stimulating the baby’s senses and
through guided play. Early teach-
ing can help high-risk children
avoid learning disabilities and help
babies interact better with others at
a much younger age.
Health care professionals
can now teach parents
simple physical exercises
that encourage the baby’s
muscle and bone growth.
Parents can learn how to
use tones of voice, ges-
tures, shapes and colors,
and toys to focus the
baby’s attention and help
its growing brain make
connections. The exciting
field of early childhood
learning is proving that
one of the healthiest
things parents can do is
to play with their baby.
41
 Having Healthy Babies: The Science Inside

Laboring to
CLB: Strip in photo Deliver Perfect
provided. Adjust Miracles
photo box as neces- When she was a little girl, Stacey
sary. Garnett loved to carry around her
aunt’s black nurses’ bag and cure the
imaginary fevers and scrapes of her
baby dolls. All that practice came in
handy; today, many of Garnett’s
patients are the same size as those
dolls from long ago.

Garnett is indeed the nurse she

dreamed of becoming, and her job
is more rewarding than she ever imagined. As the director of maternal-child
health nursing at Mercy Medical Center in Baltimore, Maryland, she gets to
witness daily miracles as she oversees the hospital’s labor-delivery unit.

“The care of a laboring woman is so exciting,” says Garnett. “Helping them

through the delivery of a baby, when everyone in the room is crying or look-
ing on in amazement or yelling, is one of the best parts of my job.”

But Garnett knows not every pregnancy has a picture-perfect ending. She
also manages the neonatal intensive unit, where sick and premature babies
are treated. Although science has made great strides in treating babies born
too early, she notes, women still need to do everything they can to carry their
babies a full nine months.

One of the most important steps women should take is also one of the easi-
est: Take prenatal vitamins. “Women should start taking prenatal vitamins if
they even think they’re going to conceive,” she stresses.

Seeing a doctor regularly is critical, since pregnancy can sometimes be

accompanied by diabetes or other life-threatening conditions.

“Doctors take blood and look at different things, like whether a woman is
anemic,” Garnett says. “They can also test to see if a woman is HIV-positive.
If she is, she and the baby can receive treatment. Doctors will also take ultra-
sounds to make sure the baby is growing properly and is in the uterus.”

42
 Part 3: How is type 2 diabetes diagnosed and treated?

Garnett feels a special concern for women who live in the inner city, since
many of them are poor and it can be hard without a car to get to a doctor.
But it’s those very women who can gain the most from medical care, she
adds. By contacting a local social service office, pregnant women often can
see doctors through the Medicaid program – and learn about other pro-
grams that can help them pay for things like groceries and infant formula.

“Many women don’t realize the resources available to them, and in most
cases, because you’re pregnant, they’re free,” says Garnett.

But Garnett is trying to spread the word. Recently, she began to travel to
area high schools to talk to students about her job. Her goal is twofold:
She wants to stress the importance of good health care to students who
may become pregnant – and she wants to encourage students to consider
entering the field of nursing.

After all, there aren’t many jobs that pay you to witness miracles.

43
Part 6: New research
about mothers and
babies
Identifying risk factors
and risk disparities
Much of today’s research on preg-
nancy and childbirth involves
counting and calculating the num-
ber of times certain risk factors
appear in certain kinds of women.
Research on risks can help pinpoint
both medical and social causes for
health problems.
For example, researchers examined
the hospital records of 38,402 black
women and 144,285 white women
who had given birth in a hospital,
looking for risk factors for eclamp-
sia. The study found that younger
women (ages 15 to 19) had a higher
Grim Statistics on Pregnancy and Childbirth
These figures come from the Safe
Motherhood Initiative of the National
Center for Chronic Disease Prevention
and Health Promotion:
• In the United States, 2 or 3 women
every day die from complications of
pregnancy.
• African-American woman are 4 times
as likely as white women to die from
complications of pregnancy. American
risk of eclampsia than older women
(ages 20 to 39). There was a higher
incidence of eclampsia among
women with diabetes and urinary
tract infections. The most impres-
sive findings showed that, regard-
less of race, women with chronic
hypertension had an 11 times
greater risk of suffering eclampsia
during pregnancy.
In general, data on risk factors are
more reliable if more cases are
counted. In one study, researchers
studied birth records for more than
11 million live births between 1995
and 1997. The study found that
women who had maternal fever
during labor had a three times
Indians are nearly twice as likely to die
as whites.
• Deaths of women from pregnancy
declined sharply between 1900 and
1982. But there has been no significant
progress since 1982.
• Up to 300,000 pregnant women in the
United States each year are victims of
violence from their intimate partners.
45
 Having Healthy Babies: The Science Inside

greater risk of related birth defects—simply by edu-

early neonatal cating women of childbearing age to
death (death add folic acid to their diets.
among prematurely
born babies) and
twice the risk Discovering causes for
of death of their pregnancy complications
full-term infants.
Scientists are making impressive
The data also
advances in discovering the actual
showed that mater-
mechanisms by which risk factors
nal fever was asso-
work. For example, researchers found
ciated with respiratory disorders in
that women with high levels of stress
both premature and full-term new-
in the midpoint of their pregnancies
born infants.
(weeks 18 to 20) were more likely to
have high levels of CRH (corti-
As researchers examine hospital and
cotropin-releasing hormone) in
Medicaid records and other data, they
their blood. High levels of CRH have
often note critical risk disparities
been linked to preterm labor. The hor-
within the population of the United
mone signals the uterus to begin con-
States. For example, research shows
tracting, which helps bring on labor.
African-American women to be at
higher risk for complications during
The race to understand and cure
pregnancy, premature births, and low
HIV/AIDS and other modern diseases
birth weight babies than white
has led to many recent advances in
women. If a particular ethnic group
immunology. Now science is starting
has a higher incidence of a medical
to connect disorders of the immune
condition, researchers look for clues in
system to miscarriage and other
the diets and lifestyles of that group
forms of pregnancy loss. Scientists
as well as in that group’s genetic
estimate that up to 40 percent of
profile. In trying to explain the dis-
unexplained infertility and up to 80
parity, researchers also look at such
percent of unexplained pregnancy loss
contributing factors as access to med-
might be due to immune system prob-
ical care.
lems. Researchers have identified
at least four autoimmune problems
Science has made clear cause-and-
that can cause frequent miscarriages.
effect connections between many risk
factors and pregnancy complications.
These findings encourage couples to
For example, lack of folic acid in the
test their immune systems before
diet has been shown to cause spina
pregnancy or in its early stages. Tests
bifida and other birth defects. This
of the immune system (such as tests
research has led to dramatic, very
for HIV/AIDS) become even more
quick progress in reducing spinal-
46
 Part 6: New research about mothers and babies
important if a mother also has
other risk factors for pregnancy
(such as being under 20 years old or
having a sexually transmitted dis-
ease).
The findings have also encouraged
doctors to prevent pregnancy loss
by treating the autoimmune sys-
tems. For example, a doctor might
prescribe aspirin or heparin to
reduce the risk of inflammation and
clotting, or prednisone, a steroid
used to treat inflammation. Contin-
uing clinical trials of these and
other treatments will establish
their safety and the most effective
way to use them.
New discoveries in genetics are also
helping scientists understand the
mechanisms of pregnancy. For
example, a study conducted in 1997
found that as many as 1 out of 7
people carried a genetic trait that
causes a deficiency in folic acid.
People carrying this trait have trou-
ble breaking down the vitamin in
their blood. A different study
showed that pregnant women with
this genetic trait might have an
increased risk of problems with the
placenta. Because of these research
results, the scientists recommended
that women with this genetic
trait take more folic acid during
pregnancy.
Evaluating prenatal
and postnatal care
Some research on pregnancy and
childbirth focuses on the medical
care that women and babies receive.
The goals of such research are often
social as well as medical. Research-
ers might try to find the best
methods of reaching women with
important health information or
find better ways to give more
women access to prenatal and post-
natal care. Some research focuses
on how doctors and hospitals
manage medical care.
A good example is the research on
caesarean sections (c-sections). The
rate of c-sections performed in the
United States rose rapidly during
the 1950s, 1960s, and 1970s. It lev- Taking part
eled off in the 1980s and then in research
began to go down. However, many projects
helps other
authorities say that the rate is still mothers and
too high: In 1995, 20.8 percent— babies be
about 1 in 5—deliveries took place healthy.
by c-section.
Researchers at the
University of Syracuse
are currently trying to
identify the factors that
cause these high rates.
Earlier research has sug-
gested that the causes
may be financial as well
as medical. For example,
researchers studied all
the hospitals in one coun-
47
 Having Healthy Babies: The Science Inside

ty in California during 1991. They A California study of more than 3,000

found that 24.9 percent of the low-income women also identified
Medicaid-insured women who gave other barriers to adequate prenatal
birth in private hospitals had care: unwanted or unplanned preg-
c-sections. In public hospitals, only nancy, lack of a regular healthcare
9 percent of Medicaid-insured women provider, and having less than a high
were given c-sections. In a different school education.
study, researchers studied 733 women
who delivered full-term infants by
unplanned c-section. The study The vital role of volunteers
found that nearly one-fourth of the
Advances in care for women and their
c-sections performed because labor
babies depend upon research volun-
was not progressing fast enough
teers. These are women who agree to
were performed too early in labor.
share information about their health
to survey takers, donate tissue sam-
Researchers also evaluate the role
ples for lab study, and participate in
of education, health insurance, and
clinical trials.
other factors in reducing pregnancy
risks. The results of such studies
Research shows huge risk disparities
show that the causes of risk dispari-
between mothers from different
ties are quite complex. Researchers
racial, ethnic, and income back-
at the University of Alabama
grounds. Women’s health research
arranged for about 300 Medicaid-
needs research volunteers from all
eligible pregnant African-American
racial and ethnic groups, of both
women to receive the usual prenatal
genders, and of all ages and lifestyles.
care. About the same number of such
women were given extra education,
Women who enroll themselves and
more clinical attention, and risk-
their babies in clinical trials stand a
reduction programs. The results
better chance of receiving potentially
showed many positive effects, such
effective treatments earlier than oth-
as an increased sense of control on
ers. At the very least, medical person-
the part of the women and greater
nel will monitor their health during
satisfaction with the health care.
the course of the trial, and they will
However, the women who received
have the best standard of care. These
the extra help did not have a lower
volunteers also get the satisfaction of
rate of low birth weight babies.
helping to uncover information that
could someday improve health for
For low-income women, the lack of
mothers, babies, families, and
health insurance is a major cause of
communities.
not seeking adequate prenatal care.

48
Conclusion: Making mothers
and babies healthier
Pregnancy, childbirth, and infant 3-7) apply to you,
care do not have to mean so much bring them to the
risk to so many mothers and attention of your
babies. Many of the worst problems doctor. Read more
can be avoided by changes in about the risk
lifestyle and following simple proce- factors and make
dures. Here are some steps you can recommended
take: changes in your
lifestyle and diet.
Educate yourself and others
about pregnancy and child- Help bring well-
birth. You have begun to do so by mother and well-
reading this book. Keep up this baby programs
education process. Check the books into your com-
and periodicals in your library. Use munity. Learn
a computer to search the Internet. from the programs
Librarians will help you in your that have succeed-
Internet search. As you read, write ed in communities
down questions. Then search for like yours. Do vol-
the key words in your questions to unteer work with local organiza-
find more information. The tions that run clinics for women,
Resources section of this book lists education programs, and similar
places to start your search. efforts. (To obtain a small grant to
support your community prevention
Recognize that you can make a program, see Healthy People 2010
difference in your own health in the Resources list on page 52.)
and the health of your baby.
It is critical that you get both pre- Volunteer for research trials.
natal and postnatal care. But just Obtain information on upcoming
as important are the health meas- trials. Volunteer yourself for a trial,
ures—healthy lifestyles, good nutri- and promote these opportunities to
tion, clean environments—that other women. Find out if your com-
mothers practice at home. munity can be a site for a research
trial on health issues related to
Identify risk factors and pre- pregnancy, childbirth, and child-
pare for them. If any of the risk care.
factors for pregnancy (see pages
49
Resources
Agency for Healthcare Research and Quality
Department of Health and Human Services
www.ahrq.gov

American Academy of Pediatrics

141 Northwest Point Boulevard
Elk Grove Village, IL 60007-1098
847-434-4000
847-434-8000 (fax)
www.aap.org, www.kidshealth.org, www.medem.com

American Diabetes Association

Promotes diabetes prevention and treatment and advocates for improved
quality of life for people with diabetes.
National Service Center
1701 North Beauregard Street
Alexandria, VA 22311
800-DIABETES or 703-549-1500
www.diabetes.org

Body Mass Index Information for Adults and Children

Provides automatic calculators of body mass index (useful for determining
risk of diabetes and other conditions based on overweight and obesity).
Found at the website of the Centers for Disease Control.
www.cdc.gov/nccdphp/dnpa/bmi/

ClinicalTrials.gov
A web-based resource for finding clinical trials in need of volunteers.
www.clinicaltrials.gov
Select the “pregnancy” topic to search for pregnancy-related trials.

Comprehensive Health Information Database

A web-based service that combines resources on maternal and child health
and other health topics from several federal agencies. A service of the
National Institutes of Health.
www.chid.nih.gov/simple/simple.html

51
 Having Healthy Babies: The Science Inside

Erikson Institute
Graduate school and research institute that specializes in early learning.
420 North Wabash Avenue
Chicago, IL 60611-5627
312-755-2250
www.erikson.edu

Healthy People 2010

A nationwide health promotion and disease prevention campaign sponsored by
the Department of Health and Human Services. One of the goals of the cam-
paign is to reduce health disparities.
Office of Disease Prevention and Health Promotion
200 Independence Avenue SW., Room 738G
Washington, DC 20201
www.healthypeople.gov
For information on the “Healthy People 2010 Microgrant” program that finances
community-based prevention activities:
www.healthypeople.gov/implementation/community/

Indian Health Service National Diabetes Program

Supports and promotes health efforts that prevent and control diabetes among
Native Americans.
Indian Health Service
5300 Homestead Road, NE
Albuquerque, NM 87110
505-248-4182

March of Dimes Foundation

The foundation maintains a massive online library of detailed information
about pregnancy, pregnancy disorders, infant and maternal health, and birth
defects and their prevention.
www.modimes.org

Medem.com
A comprehensive service of online health information, provided by members of
several medical societies.
www.medem.com

Medlineplus
A comprehensive source of health information, provided by the National Library
of Medicine.
www.nlm.nih.gov/medlineplus

52
 Resources

National Black Child Development Institute

1023 15th Street N.W., Suite 600
Washington, D.C. 20005
202-387-1281
202-234-1738 (fax)
www.nbcdi.org

National Center for Chronic Disease Prevention and Health

Promotion
Promotes the transfer of research knowledge into actual prevention and
treatment strategies. Provides information to the general public.
Centers for Disease Control and Prevention
Division of Diabetes Translation
Mail Stop K-10
4770 Buford Highway, NE
Atlanta, GA 30341-3717
800-CDC-DIAB
www.cdc.gov/diabetes/

National Center on Minority Health and Health Disparities

Promotes the health of racial and ethnic populations through research and
education and through support of minority involvement in research careers.
Affiliated with the National Institutes of Health.
6707 Democracy Blvd., Suite 800
MSC 5465
Bethesda, MD 20892-5465
800-444-6472 or 301-402-1366
www.ncmhd.nih.gov

National Institutes of Health

The biomedical arm of the federal government, which funds research and
promotes education on pregnancy and hundreds of related issues.
Website for general information about NIH publications:
www.nichd.nih.gov
See also Medlineplus for health information available to the public online.

National Women’s Health Information Center

NWHIC is a service of the Office on Women’s Health in the United States.
Department of Health and Human Services.
1-800-994-WOMAN
www.4women.gov

53
 Having Healthy Babies: The Science Inside

Native American Research Centers for Health

Research centers that link the Native American community with health research
and that work to increase the number of Native American scientists and health
professionals.
National Institute of General Medical Sciences
National Institutes of Health
45 Center Drive MSC 6200
Bethesda, Maryland 20892-6200
301-496-7301
www.nigms.nih.gov, www.nigms.nih.gov/news/releases/narch.html

New York Online Access to Health

A searchable health information resource in English and Spanish.
www.noah-health.org/index.html

Office for Protection from Research Risks

A source of information on the guidelines and ethics of research studies with
humans.
National Institutes of Health
Office for Protection from Research Risks
6100 Executive Blvd., Rm. 3D01
Rockville, MD 20892-7507

Office of Minority Health Resource Center

Serves as a national resource and referral service on minority health issues,
including pregnancy. Affiliated with the U.S. Department of Health and Human
Services.
P.O. Box 37337
Washington, D.C. 20013-7337
1-800-444-6472
www.omhrc.gov/omhrc/

54
Appendix 1: Questions to Ask
Your Doctor about Pregnancy
and Childbirth
If you want to get pregnant or think you might be pregnant...
• Am I at risk during pregnancy?
• Should I be tested for genetic traits?
• How should I change my lifestyle diet to prepare for pregnancy?
• What help is available for making those changes?

If you have been diagnosed as pregnant...

• What tests do I need right away?
• How often should I see the doctor?
• What is the treatment plan?
• What lifestyle changes are required by this treatment plan?
• What other specialists do I need to see?
• What medications should I be taking or not taking?
• With my medical history, what risks should especially concern me?
• What can I do to make pregnancy and childbirth easier?
• What are the emergency signs I should look out for?
• Can you help me locate a clinical trial to join?
• Are the conditions I am experiencing something to worry about?
• Why am I feeling this discomfort?

When you are caring for infants...

• What are the risks to my infant because of my experiences in
pregnancy?
• How often should the baby see the doctor?
• What immunizations should my baby receive, and when?
• Am I giving my baby proper nutrition?
• Why is my baby not acting like other babies the same age?
• What medications should my baby be taking or not taking?
• What are the emergency signs I should look out for?
• Can you help me locate a clinical trial to join?

55
 Having Healthy Babies: The Science Inside

Appendix 2: Taking Part in

Research Studies–Questions to Ask
A research study is a way for finding answers to difficult scientific or health
questions. Here are important questions you should ask of anyone who
wants you or members of your family or community to be part of a research
study on pregnancy, childbirth, or infant health.
1. What is the study about?
• Why are you doing this study?
• Why do you want to study me or people like me? Who else is being
studied?
• What do you want to get out of this study?
• What will you do with the results?
• Have you or others done this type of study ever before? Around here?
What did you learn?
2. Who put this study together?
• Who is running or in charge of this study?
• Whose idea was this study?
• How were people like me part of putting it together?
• Who are the researchers? Are they doctors or scientists? Who do they
work for?
• Have they done studies like this before?
• Is the government part of this study? Who else is a part of this study?
• Who is paying for this study?
• Who will make money from the results of this study?
3. How can people like me share their ideas as you do this study?
• How will the study be explained in my community?
• Who of people like me will look at this study before it starts?
• Who of people like me are you talking to as you do this study?
A Community Advisory Board?
• Who from the study can I go to with ideas, questions, or complaints?
• How will people like me find out about how the study is going?
4. Who is going to be in this study?
• What kinds of people are you looking for? Why?
• Are you trying to get minorities in this study?
• Are you including people less than 18 years old?
• How are you finding people for this study?
• Are transportation and/or daycare provided for people in this study?
• Do I need to sign to participate?
56
 Appendix

• Will you answer all of my questions before I sign the consent form?
• Can I quit the study after signing the consent form? If I quit the study,
will anything happen to me?
5. What will I get out of this study?
• What are the benefits?
• Is payment involved? How will I be paid?
• Will I get free health care or other services if I participate? For how long?
• Will I get general health care and/or psychological care if I participate?
For how long?
6. How will I be protected from harm?
• Do I stand a chance of being harmed in this study? In the future?
• Does the study protect me from all types of harm?
• If I get harmed, who will take care of me? Who is responsible?
• If I get harmed in any way, will I get all needed treatment?
Who pays for treatment?
7. How will my privacy be protected?
• Who is going to see the information I give?
• Will my name be used with the information?
• What happens to the information I gave if I quit the study?
• Is there a written guarantee of privacy?
8. What do I have to do in this study?
• When did you start this study? How long will it last?
• How much of this study have you already done?
• Have there been any problems so far?
• Will I get treated the same as everyone else?
• What kinds of different treatments are offered in this study? Are there
both a real and a fake treatment?
9. What will be left behind after the study is over?
• What will happen to the information people give? How will it be kept?
• What are you going to do with the results of the study?
• How will the public learn about the results? Will results be in places
where the public can see them?
• Are you going to send me a copy of the results? When?
• What other studies are you planning to do here?

The questions above are from a pamphlet developed by Project LinCS (Linking Communities
and Scientists), Community Advisory Board (Durham, NC), and Investigators (University of
North Carolina Center for Health Promotion and Disease Prevention) in cooperation with the
Centers for Disease Control and Prevention, Atlanta, GA, email: hivmail@cdc.gov. For copies
of this brochure: CDC National Prevention Information Network 1-800-458-5231

57
 Having Healthy Babies: The Science Inside

Appendix 3: Recommended
Childhood and Adolescent
Immunization Schedule
RECOMMENDED CHILDHOOD AND ADOLESCENT IMMUNIZATION SCHEDULE •
UNITED STATES • 2003

58
 59
FOOTNOTES
RECOMMENDED CHILDHOOD AND ADOLESCENT IMMUNIZATION SCHEDULE • UNITED STATES • 2003
Appendix
Bibliography
Avraham, Regina. Reproductive System. Broomball, PA: Chelsea House
Publishers, Inc, 2001.
Bainbridge, David. Making Babies: The Science of Pregnancy. Cambridge, MA:
Harvard University Press, 2001.
Ellison, Peter T. On Fertile Ground: A Natural History of Human Reproduction.
Cambridge, MA: Harvard University Press, 2001.
Fenwick, Elizabeth. Childbirth. NY: DK Publishing, 1996.
Fenwick, Elizabeth. Healthy Pregnancy. NY: DK Publishing, 1996.
Gay, Kathlyn. Encyclopedia of Women’s Health Issues. Phoenix: Oryx, 2002.
Jefferson, Thomas C., and Tracy Irons-Georges (Eds.). Children’s Health, Volumes
1 and 2. Pasadena, CA: Salem Press, 1999.
Klaus, Marshall H., and Phyllis H. Klaus. Your Amazing Newborn. Cambridge,
MA: Perseus Publishing, 1998.
Lamb, Kirsten. Pregnancy. Austin, TX: Steck-Vaughn Company, 2002.
Markel, Howard and Frank A. Oski. Practical Pediatrician: The A to Z Guide to
Your Child’s Health, Behavior, and Safety. NY: W.H. Freeman & Co., 1996.
Miller, Steve Z., and Bernard Valman. Children’s Medical Guide: The Quick
Reference Guide to Children’s Symptoms. NY: DK Publishing, 1997.
Minkin, Mary Jane, and Carol V. Wright. The Yale Guide to Women’s Reproductive
Health: From Menarche to Menopause. New Haven, CT: Yale University Press,
2003.
Nathanielsz, Peter W. Life Before Birth: The Challenges of Fetal Development.
NY: W.H. Freeman & Co., 1996.
Pinon, Ramon, Jr. Biology of Human Reproduction. Sausalito, CA: University
Science Books, 2002.
Reynolds, Karina Christoph Lees, and Grainne McCartan. Pregnancy and Birth:
Your Questions Answered. NY: DK Publishing, 1997.
Sears, William and Martha. The Baby Book: Everything You Need to Know About
Your Baby–from Birth to Age Two. Boston: Little, Brown, 1993.
Stoppard, Miriam. Complete Baby and Child Care. NY: DK Publishing, 1995.
Thoennes Keller, Kristen. Health Care for Infants and Toddlers. Minneapolis:
Capstone, 2001

61
Glossary
al•pha-fe•to•pro•tein (AFP): a pro-
tein that is produced by a growing
fetus. It is found in the amniotic fluid,
the fetus’s blood, and the mother’s
blood.
al•pha-fe•to•pro•tein screen•ing:
blood testing that measures the levels
of alpha-fetoprotein (AFP) in the moth-
er’s blood. A higher than normal
amount of AFP can indicate brain and
spinal cord defects. A lower than nor-
mal amount of AFP can indicate a baby
with Down syndrome. This screening
can also give the exact due date and
the presence of more than one fetus.
am•ni•o•cen•te•sis: a test of the
fluid that surrounds the developing
fetus, usually performed between weeks
15 and 20 of pregnancy. Cells from the
fetus are used to detect genetic disor-
ders such as Down syndrome, sickle
cell, anemia, and cystic fibrosis and
abnormalities such as spina bifida.
Also detects the sex of the fetus.
am•ni•ot•ic flu•id: the fluid that fills
the womb during pregnancy. It provides
a fluid, cushioned environment for the
fetus.
a•ne•mi•a: an inadequate level of
hemoglobin in the blood; a shortage of
red blood cells.
an•en•ceph•a•ly: a fatal neural tube
defect in which the baby is born with a
severely undeveloped brain.
antibiotic: a drug that kills bacteria.
an•ti•bod•ies: disease-fighting agents
in the blood.
Ap•gar score: a score given to a new-
born infant after a simple tactile test of
the infant’s responses.
bac•te•ri•a: tiny organisms that sur-
vive on living and nonliving surfaces,
performing many chemical functions.
Some bacteria, such as listeriosis, cause
diseases in people.
birth ca•nal: the channel that the
fetus passes through during birth. It is
formed by the cervix, vagina, and vulva.
birth cen•ter: a medical facility
designed for giving birth, often located
within a hospital.
birth con•trol: reducing or eliminat-
ing the chance of pregnancy.
birth de•fects: diseases or conditions
that are present at birth, such as cystic
fibrosis and spina bifida.
birth po•si•tion: the position of the
baby in the birth canal. Normal posi-
tion is head down. In the breech posi-
tion, the baby’s feet point toward the
birth canal.
break•ing wa•ter: the release of the
amniotic fluid, a clear signal that labor
is beginning.
breast•feed•ing: feeding an infant on
its mother’s natural milk. This is the
recommended method for feeding new-
born babies.
breech birth: when the baby emerges
from the birth canal feet first, instead
of the usual head first. This makes for
a more complicated delivery.
cae•sa•re•an sec•tion (c-sec•tion):
delivery of a baby by surgically cutting
into the uterus.
Can•a•van dis•ease: a rare, inherit-
ed disorder that usually affects children
of Eastern European Jewish descent.
Symptoms may include mental retarda-
tion, loss of motor skills, feeding diffi-
63
 Having Healthy Babies: The Science Inside
culties, poor head control, and an
enlarged head. The disease usually
results in death by age 10.
cell: the smallest unit of production in
a living thing.
cer•e•bral pal•sy: caused by a prena-
tal brain defect or by brain injury dur-
ing birth; characterized by spasms and
difficulty in controlling the muscles.
cer•vix: the neck-like part of the
uterus that extends into the vagina. It
becomes the beginning of the birth
canal.
chla•my•di•a: a sexually transmitted
disease caused by bacteria.
cho•ri•o•car•cin•o•ma: cancer that
can develop in molar tissue that was
not removed by surgery after a molar
pregnancy.
cho•ri•on•ic vil•lus samp•ling
(CVS): a test performed in the 10th to
12th week of pregnancy that identifies
the same abnormalities as amniocente-
sis. CVS can also detect the baby’s sex
and risk of spina bifida.
chron•ic: long-lasting and on-going.
Diabetes and high blood pressure are
chronic diseases that put pregnant
women at risk.
clin•i•cal tri•als: research that is
performed using people to test the suc-
cess of a medical treatment, medicine,
or prevention strategy. A clinical trial
usually is conducted only after the test
has been successful in the laboratory
and on animals.
com•pli•ca•tions of preg•nan•cy:
problems that are not expected in a
healthy pregnancy. These include birth
defects, illness at birth for the mother
or baby, injury or death to the newborn,
and injury or death to the mother.
64
con•cep•tion: the fertilization of an
egg from a female by sperm from the
male.
con•gen•i•tal: present at birth.
con•gen•i•tal ru•bel•la
syn•drome (CRS): a group of severe
birth defects, including mental retarda-
tion, heart disease, deafness, and
cataracts.
con•sti•pa•tion: slowed bowel activi-
ty. In late pregnancy, it is often caused
by pressure from the growing baby.
con•su•mer guide•lines: published
by government agencies and trade
organizations to help people choose
safe products, such as car seats, cribs,
playpens, and other baby furniture,
and to use them correctly.
CRH (cor•ti•co•tro•pin
re•leas•ing hor•mone): a protein
produced in the body that commands
the body’s response to stress.
cys•tic fi•bro•sis: a serious heredi-
tary disease that results in serious res-
piratory and other health problems, as
well as early death (often in the teens
and early 20s, although because of
medical advances, the average life
span for someone with this disease is
now 30).
da•ta: collections of statistics, such as
those gathered from hospital records.
di•a•be•tes: a set of illnesses charac-
terized by improper amounts of glucose
(sugar) in the blood. Gestational dia-
betes is a form that occurs during
pregnancy.
di•ag•no•sis: a professional medical
opinion, based on an exam of the
patient, about what is causing symp-
toms of illness.
e•clamp•si•a: life-threatening condi-
tion characterized by swelling, seizures,
high blood pressure, and protein in the
urine.
 Glossary
ec•top•ic preg•nan•cy: a pregnancy
in which the fetus develops outside the
womb, usually in the fallopian tube.
Also called tubal pregnancy.
em•bry•o: a fertilized human cell very
early in a pregnancy, before it develops
into a fetus.
en•do•me•tri•o•sis: a condition that
occurs when bits of the endometrium
(the tissue that lines the uterus) escape
the uterus and become implanted on the
ovaries, fallopian tubes, or other pelvic
organs.
ex•pec•ted de•liv•er•y date: the
date when a baby is expected to be born.
The date is calculated at 40 weeks from
the start of the last menstrual period.
fail•ure to thrive: a term used when
an infant is consistently behind normal
growth for its age group.
fal•lo•pi•an tube: a tube that leads
from the ovary to the uterus.
fer•til•i•ty drugs: medications, often
hormones, which regulate or bring
about ovulation.
fer•til•i•za•tion: when a male sperm
cell joins with a female egg to form an
embryo.
fe•tal al•co•hol syn•drome: a group
of birth defects, suffered by babies born
with alcohol in their bloodstreams, that
include mental retardation, heart prob-
lems, and abnormal brain development.
fe•tal po•si•tion: the position of the
unborn child within the womb. See also
birth position.
fe•tus: an unborn child still in the
womb. An embryo develops into a fetus
in about the 10th week of pregnancy.
fol•ic a•cid: a form of vitamin B con-
tained in leafy green vegetables, dried
beans, citrus fruits, and other foods.
Recommended for all women of child-
bearing age to prevent birth defects and
to reduce risks of illness and complica-
tions of pregnancy.
fol•ic a•cid de•fi•cien•cy: a short-
age of folic acid in the body.
Gau•cher’s dis•ease: an inherited
disorder in which harmful amounts of a
fatty substance build up in the spleen,
liver, lungs, bone marrow, and, in rare
cases, the brain.
genes: units of hereditary information
contained in each cell of the body.
ge•net•ic: inherited.
ge•net•ic pro•file: an outline of the
diseases or conditions a person might
have inherited to determine the risk for
passing a condition on to their children.
ge•net•ics: the field of science that
looks at how genes are passed down
from one generation to another to influ-
ence traits.
ge•net•ic trait: a physical characteris-
tic that is passed down through the
genes.
Ger•man mea•sles: See rubella.
ges•ta•tion•al di•a•be•tes:
See diabetes.
ges•ta•tion•al hy•per•ten•sion:
high blood pressure that develops
during pregnancy, which may be an
indication of preeclampsia.
guid•ed play: teaching an infant or
young child in specific ways that devel-
op his or her motor skills and learning
ability.
he•mo•glo•bin: the coloring matter in
red blood cells. Its main purpose is to
move oxygen from the lungs to the tis-
sues of the body.
65
 Having Healthy Babies: The Science Inside
hep•a•ti•tis B: a disease of the immune
system characterized by weight loss,
fatigue, and jaundice and which is often
sexually transmitted.
high blood pres•sure: a condition in
which blood is pushed through the body’s
blood vessels at greater force than nor-
mal. It can lead to tiredness, heart
attack, stroke, and other health problems.
High blood pressure is also known as
hypertension.
high risk: a term used to describe condi-
tions or people that stand a good chance
of developing negative outcomes.
high-risk preg•nan•cy: pregnancy in
which there are one or more factors that
have been associated with miscarriages,
complications of pregnancy, premature
deliveries, low-birth-weight babies, and
other negative outcomes.
HIV/AIDS: AIDS (acquired immune defi-
ciency syndrome) is a disease of the
immune system caused by the presence of
HIV (human immunodeficiency virus). It
is passed on through sexual intercourse
and exposure to infected blood.
home preg•nan•cy test: a self-adminis-
tered test of whether a woman is preg-
nant. The test indicates the presence or
lack of a hormone that is produced during
pregnancy.
hor•mone: a protein produced by an
organ of the body to trigger activity in
other locations. Insulin is an example of a
hormone.
hy•dro•ceph•a•lus: too much fluid in
the brain. This condition occurs most
often to infants and causes the head to
greatly increase in size.
hy•per•ten•sion: another term for high
blood pressure.
66
im•mune sys•tem: the coordinated
responses of the body that serve to pro-
tect it against outside invaders such as
viruses and bacteria.
im•mu•ni•za•tion: producing resist-
ance to a disease by injecting the patient
with a weakened form of the disease or
with the antibodies for the disease.
im•mu•nol•o•gy: the branch of medi-
cine that deals with the body’s response
to disease.
in•com•pe•tent cer•vix: a condition in
which the cervix is weakened by the pres-
sure of the growing baby. It can bring on
premature labor.
in•cu•ba•tor: an enclosed, warmed
bassinet that serves as a temporary
womb for premature babies or other
infants who cannot survive on their own.
in•fant for•mu•la: an artificial substi-
tute for a mother’s breast milk.
in•fec•tion: invasion of body tissue by a
virus or harmful bacteria, resulting in
disease.
in•fer•til•i•ty: the inability to conceive
or bear children.
in•su•lin: a hormone released by the
pancreas that regulates blood sugar levels
by helping body tissues take in glucose
(sugar) to be used for energy.
in•tra•ve•nous feed•ing: nutrients
given through the vein.
in vi•tro fer•til•i•za•tion: procedure
in which the egg and sperm are joined in
the laboratory and then transferred to
the uterus.
Keg•el ex•er•cis•es: a series of exercis-
es of the pelvic muscles to help bladder
control and strengthen the muscles need-
ed for childbearing.
kid•neys: the pair of organs that filters
the blood and gets rid of waste products
through the urine.
 Glossary
La•maze: a series of techniques for
controlling pain during labor and deliv-
ery through breathing and other natu-
ral methods.
lis•te•ri•o•sis: a common disease-car-
rying bacteria to which pregnant
women are particularly susceptible.
This bacteria in pregnant women may
lead to miscarriage or stillbirth.
low birth weight: weighing less than
5 pounds 8 ounces at birth. Babies with
low birth weight are at greater risk for
health problems and learning disabili-
ties.
lupus: a chronic disease that causes
pain and inflammation of the joints, as
well as rashes across the nose and
cheeks.
men•stru•a•tion, men•stru•al
pe•ri•od: the discharge of blood and
tissue from the lining of a woman’s
uterus each month.
mid•wife or nurse-mid•wife: a
nurse who is trained in pregnancy,
labor, and delivery. Midwives can deliv-
er babies in or outside the hospital but
usually have emergency physician
backup.
mis•car•riage: the loss of a develop-
ing baby during the first 20 weeks of
pregnancy. The medical term is sponta-
neous abortion.
mo•lar preg•nan•cy: a pregnancy in
which the fetus does not develop
because the placenta develops abnor-
mally. It requires surgery to save the
mother’s life.
mood dis•ord•ers: mental health
problems, such as depression and
mania, relating to a person’s frame of
mind.
morn•ing sick•ness: nausea and
vomiting caused by pregnancy. Can
occur at any time of day, and usually is
most frequent in the first trimester.
mu•cous plug: a small mass of soft
tissue that covers the opening of the
cervix during pregnancy, sealing off the
womb.
ne•o•na•tal: newborn.
neonatal intensive care unit
(NICU): the part of a hospital that
takes care of premature and other high-
risk babies in artificial environments.
neu•ral tube de•fects: birth defects,
such as spina bifida, that affect the
brain and spinal cord.
o•be•si•ty: the condition of being
overweight. It is a risk factor for preg-
nancy.
ob•ste•tri•cian: a doctor who special-
izes in the care of pregnant women and
their developing babies.
o•var•y: the female reproductive
gland. This is the organ that produces
eggs in the female.
ov•u•la•tion: the process of shedding
an egg from the ovary.
pan•cre•as: a gland near the stomach
that secretes the hormone insulin.
par•a•site: an organism that lives off
of another organism. Viruses, most bac-
teria, and some worms are parasites.
pel•vic in•flam•ma•tor•y dis•ease
(PID): an infection of the lining of the
uterus, the fallopian tubes, or the
ovaries.
per•i•na•tal care: care of premature
infants in artificial environments that
copy the conditions in a healthy moth-
er’s womb.
pla•cen•ta: a structure that forms
from the lining of the uterus during
pregnancy. It is responsible for nourish-
ing the fetus, providing it with oxygen,
and eliminating its wastes.
67
 Having Healthy Babies: The Science Inside
post•na•tal care: care of the infant
after birth.
post•par•tum de•pres•sion: depres-
sion that occurs after and as a result of
pregnancy and childbirth.
post•par•tum psy•cho•sis: severe
mental problems that occur after and
as a result of pregnancy and childbirth.
pre•e•clamp•si•a: a disease that is
characterized by a combination of high
blood pressure and increased protein in
the mother’s urine. Severe preeclampsia
reduces the flow of oxygen and nutrients
from the placenta to the fetus and can
lead to life-threatening organ damage and
seizures in the pregnant woman. Mild
PIH can usually be kept under control
until birth, but severe cases may require
preterm delivery. See also eclampsia.
pre•ma•ture in•fant: a baby born
three or more weeks before the expected
due date. Babies as young as 25 weeks
have a good chance of survival with peri-
natal care.
pre•ma•ture or pre•term
de•liv•er•y: delivery that takes place
three or more weeks before the expected
due date of the baby.
pre•ma•ture or pre•term la•bor:
labor that takes place three or more
weeks before the expected due date
of the baby.
pre•na•tal care: care of the unborn
baby and its mother during pregnancy.
rheu•ma•toid ar•thri•tis: a chronic
disease that causes the joints to become
inflamed.
risk dis•par•i•ty: a noticeable differ-
ence in risk data between members of one
racial, ethnic, or social group and the pop-
ulation as a whole.
risk fac•tor: any medical or social condi-
68
tion that might contribute to a negative
medical outcome.
ru•bel•la (Ger•man meas•les): a com-
mon childhood disease carried by a virus.
It can infect the bloodstream of the fetus
and cause pregnancy complications and
birth defects.
scle•ro•der•ma: a serious disease in
which all the layers of the skin become
hardened and rigid.
sei•zure: uncontrollable muscle spasms,
as of epilepsy or some other disease.
sex•u•al•ly trans•mit•ted dis•eas•es
(STDs) or in•fec•tions (STIs): diseases
caused by viruses and bacteria that are
passed on through sexual intercourse.
shaken baby syndrome: a severe head
injury that occurs when a baby is shaken
hard enough to cause the baby’s brain to
bounce against the skull. This can cause
severe brain injury or even death.
sick•le cell dis•ease: an inherited form
of anemia characterized by C-shaped red
blood cells.
spi•na bi•fi•da: a birth defect in which
the tissue surrounding a baby’s develop-
ing spinal cord does not close properly.
Also called “open spine,” it affects the
backbone and the spinal cord and can
cause paralysis of the legs, as well as
problems with bladder and bowel control.
spon•ta•ne•ous a•bor•tion: medical
term for miscarriage.
spot•ting: leaking small amounts of
blood from the vagina during pregnancy
or between menstrual periods.
sta•tis•tics: a collection of numerical
data.
still•birth: delivery of a baby who has
died in the womb after the 20th week of
pregnancy.
 Glossary
stroke: damage to the blood vessels in
the brain that can result in the inabili-
ty to speak or move part of the body.
sud•den in•fant death syn•drome
(SIDS): sudden and unexplained death
of a baby under one year of age.
Putting the baby to sleep on its back
has been shown to reduce SIDS.
symp•tom: a sign of a problem, such
as a disease.
Tay-Sachs dis•ease: a fatal inherited
disease of the central nervous system.
Symptoms usually first appear at 4 to 6
months of age, resulting in death by
age 5. The disease occurs most fre-
quently in descendants of Central and
Eastern European (Ashkenazi) Jews.
thal•as•se•mi•a: a group of inherited
diseases of the blood that affect a per-
son’s ability to produce hemoglobin,
resulting in anemia.
tox•o•plas•mo•sis: an infection
caused by a parasite present in cat
feces. If infected while pregnant, a
woman can pass the disease on to her
unborn child.
tri•mes•ter: one of three 3-month
periods into which a pregnancy is
divided.
ul•tra•sound test: sonar imaging
technology that allows experts to take
“pictures” of internal operations, such
as the development of a baby in the
womb. Used to monitor the health of
high-risk and other infants.
um•bil•i•cal cord: the cord that con-
nects the fetus to the placenta, allowing
nourishment to the fetus. It is cut and
removed during childbirth.
u•ter•us: the organ of the female
reproductive system in which an
unborn baby develops. In pregnancy,
the uterus is also known as the womb.
va•gi•na: a duct that connects the
uterus and the exterior of the body.
vag•i•nal birth: the routine process of
birth, during which the baby emerges
through the birth canal.
vi•rus: a tiny organism that carries
disease. It spreads throughout the body
by using the body’s cells to make copies
of itself.
vi•ta•mins: organic substances that
provide the body with essential nutri-
ents.
vul•va: the outer female genitals.
womb: See uterus.
69
 Having Healthy Babies: The Science Inside

Acknowledgements
Project Advisors

Philip Abelson, PhD

American Association for the Advancement of Science (AAAS)

Yolanda Cuesta
Cuesta Multicultural Consulting

Yolanda George
American Association for the Advancement of Science (AAAS)

Robert D. Goldman, PhD

Northwestern University Medical School

Max Gomez, PhD

WNBC, Health & Science Editor

Beatrix (Betty) Ann Hamburg, MD

Cornell University Medical College

Marcia Harrington
District of Columbia Public Library

Constance Hendricks, PhD

Chair, Graduate Nursing Programs
Southern University and A&M College School of Nursing

Eric Jolly, PhD

Education Development Center Inc. (EDC)

Betty Lawrence
Rochester Public Library, New York

Audrey Manley, PhD

President Emerita, Spelman College

Marsha Lakes Matyas, PhD

The American Physiological Society

Sandra Negro
Senior Librarian, Wheaton Library, Maryland

70
 Acknowledgments

Delores Parron, PhD

Scientific Advisor for Capacity Development
Office of the Director, National Institutes of Health

Joseph Perpich, MD, PhD

J.G. Perpich, LLC

Marcy Pride, MLS, MA

Director, Oyer Memorial Library
Washington Bible College and Capital Bible Seminary, Lanham, Maryland

Josefina Tinajero, EdD

Associate Dean, College Of Education
University of Texas at El Paso

Maternal and Infant Care Content Reviewers/Advisors

Stacey Garnett, RN, MS

Director of Maternal-Child Health Nursing
Mercy Medical Center, Baltimore, Maryland

Jacqueline Novak, PhD

Assistant Professor
Dept. of Obstetrics, Gynecology and Reproductive Sciences, University
of Pittsburgh School of Medicine and Magee-Womens Research Institute

Frank Tillman III

Dept. of Obstetrics, Gynecology and Reproductive Sciences, University of
Pittsburgh School of Medicine and Magee-Womens Research Institute

Project Staff and Consultants

Shirley M. Malcom, Principal Investigator

Maria Sosa, Co-Principal Investigator and Project Director
Kirstin Fearnley, Project Manager
Mary Chobot, PhD, Library Consultant and Project Evaluator
Ann Williams, Art Director
Susan Mahoney and Associates, Janet Mednick, Sarah Pekkanen, Writers
Tracy Gath, Writer, Editor
Betty Calinger, Editor
Maggie Sliker, Photo Researcher
Heather Beecheler, Chickona Royster: Project Associates

Special thanks go to Nathan Bell, Harriet Pickett, Catherine Baker, and

Lisa Boesen for their assistance with the development of this book series.

71
 Having Healthy Babies: The Science Inside

Photo Credits:
Cover: EyeWire Images and Eric Nevin.
Page 1: © Ariel Skelley/CORBIS.
2: Ken Hammond/USDA # 02cs2024.
5: PictureQuest.
6: LifeArt.
7: Custom Medical Stock Photo (CMSP) # Z071-ss-691.
8: Ken Hammond/USDA # 02cs2008.
9: Eric Nevin.
11: Custom Medical Stock Photo (CMSP) # Z361-N-34.
12: Joseph Morton Photos.
13: LifeART.
14: Eyewire Images. Parenting Today #PTO_093.
15: Cara Bowen-Golderg.
17: Ken Hammond/USDA # 02cs2019.
19: © Laurent/Dr. Gaillard/Photo Researchers, Inc.
21: CDC/Public Health Image Library # 1086.
23: Custom Medical Stock Photo (CMSP) # Z353-N-1334 (2).
24: Custom Medical Stock Photo (CMSP) # Z191-NN-349.
25: Oscar Moresi Photography.
29: Custom Medical Stock Photo (CMSP) # Z400-N-124.
32: Visuals Unlimited.
34: PhotoLab Vol.2 Medical & Technology # 2048.
37: Ken Hammond/USDA # 93cs0006.
38: Katrina Malloy.
41: © Laura Dwight/CORBIS.
42: Louis Rosenstock.
43: Ken Hammond/USDA # 93cs0010.
44: Eyewire Images. Parenting Today #PTO_070.
46: © Laura Dwight/CORBIS.
47: Ken Hammond/USDA # 02cs2018.
49: Ken Hammond/USDA # 93cs0012.
50: Eyewire Images. Parenting Today #PTO_079.
59, 60: Schedule courtesy ImmunizationEd.org.

72